Word on the Street

• Voices: "Mold is largely an issue of the past and is rapidly receding as an issue of the present." -Charlie Titterton, a director is Standard & Poor's insurance ratings, quoted in a press release for S&P's report, "U.S. Personal Lines Insurance Outlook 2003: On the Path to Profitability"
• Grande Ole Stachy: Schools all around the country are finding out the effects of mold exposure on bankbooks. Symptoms of choking expense accounts due to mold are being felt nationwide, not just by the usual victims like the residents of Texas and Florida.
  Perhaps the educational funds in no other state are being hit as hard as those in Tennessee, where cases upon cases of mold in schools are costing taxpayers millions of dollars and may have accounted for the death of one 17-year-old student. Separate instances in several cities across the Volunteer State have resulted in missed schooldays, surrogate classrooms, estimated bills sometimes as much as $1 million, and even lawsuits alleging health effects due to prolonged exposure.
  The lesson learned was an important one: the value of advance cleanup, as opposed to post-disaster restitution. John O'Dell, director of Sullivan County (Tenn.) Schools, told The Associated Press, "I think we're all more sensitive to it now. We've told the principals and custodians to keep an eye out for any discolored tile and then replace it immediately."
• Strano Departs AIHA: the day before it's office Christmas party, AIHA handed a pink slip to Richard Strano, CAE, its Executive Director. Strano left a comfortable position at ACGIH last year after being recruited to take the staff leader role at AIHA. Among his first tasks were helping the association achieve financial stability and better staff support. While the organization significantly restructured its administrative staff in 2002, it ended the year with a financial deficit.
• High stakes: AAF-McQuay Inc. entered into a $170 million bank credit agreement to refinance its $100 million bank credit facility and retire its senior unsecured notes that will come due in February.
  The new bank credit agreement carries a five-year term with a declining pricing grid based on performance. Banc of America Securities LLC was the sole lead manager for syndicating the new credit facility, which has nine bank participants.
  "This new financing will significantly reduce the company's interest cost and will provide flexibility to pursue future growth opportunities," said Vice President of Finance Bruce Krueger. "AAF-McQuay's strong cash flow over the past three years has resulted in debt reduction of over $119 million from Sept. 30, 1999, to Sept. 30, 2002."
• Insurance Bandwagon: Thirty-four states and the District of Columbia have adopted an approved Insurance Services Office mold limitation for homeowners coverage, which allows insurers to exclude coverage for loss caused by mold and wet or dry rot, unless the conditions result from a covered peril. According to the National Association of Independent Insurers, a separate limit for mold damage resulting from a covered peril may be added by endorsement.
  "These limitations, coupled with the recent reduction of damages by the Texas appeals court in the Ballard case, could help introduce some stability in the nation's homeowners market," said Dave Golden, director of commercial lines for the NAII.
  The 34 states that have adopted ISO's mold endorsement are: Alabama, Arizona, Colorado, Delaware, Idaho, Indiana, Iowa, Kansas, Kentucky, Maine, Massachusetts, Michigan, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, South Dakota, Tennessee, Utah, Vermont, West Virginia, Wisconsin and Wyoming.
  Under the terms of the ISO endorsements, coverage for mold-related damages are excluded unless they result from a covered peril of water damage such as accidental discharge or overflow of water or steam or windstorm, and are covered under policy limits. ISO is endorsing new limitations and options for homeowners, including a basic limit option of $10,000 on an annual aggregate basis for loss caused by fungi, wet or dry rot or bacteria, including the cost of mold removal and expenses involving tearing out and replacing any part of the property to gain access to the mold.
• BBJ Nabs Registration: BBJ Environmental Technologies, Inc. of Tampa, Fla., recently was granted an Environmental Protection Agency  registration for BBJ Microbiocide for Air Ducts, its new antimicrobial product for use in air duct systems.
  "We believe that this technology will revolutionize the Duct Cleaning Industry by providing the HVAC/R industry with an effective product that serves the needs of both technicians and building occupants. We also believe that this first of its kind registration is extremely important, not only to BBJ and the growth of the company but more importantly, to the health and comfort of people who work and live in modern buildings with highly controlled environments," said Bob Baker, Chairman of the Board of BBJ Environmental Technologies, Inc.
• Burge Resigns From IOM: Dr. Harriet Burge has resigned from the Institute of Medicine's work group on Damp Indoor Spaces and Health. She had served as chair and member of the committee since its inception in January 2002. Dr. Noreen Clark, dean of the University of Michigan School of Public Health, replaces Burge as chair, and Dr. Aino Nevalainen, a senior researcher at the Academy of Finland, has been added to the committee. Funded by the Centers for Disease Control and Prevention, the IOM is conducting a comprehensive review of the scientific literature regarding the relationship between damp or moldy indoor environments and the manifestation of adverse health effects, particularly respiratory and allergic symptoms. The final report is expected this summer.
• Green Building Man: The U.S. Green Building Council named New York State Gov. George Pataki the first recipient of its Green Building Leadership Award at its premiere International Green Building Conference and Exposition in November. The award was established by the USGBC to recognize a body of government or non-profit organization, or an individual working for such organization, for significant contribution to advancing and causing the transformation of green building in the public sector. Carrier Corp. of Syracuse, N.Y., had nominated the governor for the award.
  "Gov. Pataki stands apart among elected leaders for his tireless efforts to promote green building and sustainable design," said John Mandyck, Carrier's Vice President for Government and International Relations.
• Correction: Due to a printer error, the AIHA EMLAP accredited laboratory logo on the advertisement for Aerobiology Laboratories  Associates Inc. did not print in the December 2002 ad.

The alphabet soup that makes up the certification designations for the IAQ industry just got even more diluted. The recent announcement of a new pair of indoor air quality certifications by the American Indoor Air Quality Council, said to replace two other certification designations previously offered in partnership with the Association of Energy Engineers, has had members of the certification industry questioning each other's motives.
The AMIAQ Council announced in November 2002 that in the new year it would no longer offer review courses and examinations from AEE. AMIAQ was licensed by AEE to offer the CIAQP and CIAQT programs, the Certified Indoor Air Quality Professional and Certified Indoor Air Quality Technician. Instead, the AmIAQ Council designed two new certification programs it said replaces those courses.
One of the courses that the AmIAQ Council says it is replacing will actually continue to be offered elsewhere in 2003. The Association of Energy Engineers will continue to offer its CIAQP examination and training program in conjunction with Chelsea Group Ltd., a fully licensed provider of training for both AEE and the Indoor Air Quality Association.
This is a point acknowledged by Charlie Wiles, executive director of the AmIAQ Council. He said the council's announcement intentionally did not go out of its way to mention the CIAQP. "We have our own certification that replaces it," he said. "Why should I go ahead and advertise [AEE's] program? There was nothing sinister about that. Why should I even go there?"
Wiles, who said he normally conducts his interviews by e-mail only, granted IE Connections a spontaneous telephone interview late on a Friday afternoon. He spoke openly and candidly, responding in full to every question posed.
In addition, separate phone interviews conducted that day with AEE Executive Director Al Thumann and Chelsea Group Chairman and CEO George Benda yielded similar results.

Heart Of It All
At the heart of it all is the CIAQT, the Association of Energy Engineers' Certified Indoor Air Quality Technician program. This designation was adopted in 1999 as a response to a market trend, said Al Thumann. He explained that the CIAQT does not require an engineering background, while one of the prerequisites for the CIAQP is a four-year degree or higher in engineering, science, architecture, business or a related field.
"Several individuals with a non-engineering background approached us. They wanted to go through a similar program to CIAQP but couldn't qualify," Thumann said. The CIAQT broadened the eligibility requirements to two or more years of experience in a career relevant to the field of building science.
AEE announced in 2002 that it would no longer be the certifying body for the CIAQT. However, the certified indoor air quality technicians who received this designation, about 250 in all, would be "grandfathered" under the CIAQP program, said Thumann.
The American Indoor Air Quality Council announced a new professional certification to replace the outgoing CIAQT. "Since they no longer want to be the certifying body for [CIAQT], we developed our own certification," said Charlie Wiles. The council introduced the CIAQI, or the Certified Indoor Air Quality Investigator.
According to the council's Web site, those already holding the CIAQT designation may "grandfather" into the CIAQI certification "at no cost (free) during the remainder of their current certification period."

Professional
At the same time of the CIAQT/CIAQI announcement, the American Indoor Air Quality Council announced that it had dropped the Association of Energy Engineers' CIAQP program in favor of the new CIAQC program, which stands for Certified Indoor Air Quality Consultant.
AEE's Al Thumann said the decision came on the heels of the CIAQP program's most notable update ever. "We have upgraded our program," he said. "It used to be two days, and now it's three days. It [now] addresses issues of toxic mold remediation and bioterrorism.
"As a result, any program that was going to be taught would need to be up to our standards. Maybe other groups didn't want to go through the revisions to meet our approval," he said. "The program has evolved and is really our flagship program. This is the only one that we will be offering in 2003."
The revisions definitely affected George Benda, the senior principal at Chelsea Group, which adapted to the new changes within AEE's CIAQP program. He said that AEE gave the AmIAQ Council the option of adapting to the new program: "They were offered the opportunity to get a license for the program from AEE as they had in the past, which would have meant upgrading their program to the new learning and skill criteria. They opted not to do that, and they need to state their reasons."
Given the question, Wiles answered, "Part of the reason is because the examination for CIAQP had not been changed in six years. We also attempted to buy it out three different times. They didn't sell it to us, so we chose to do our own. I've got nothing bad to say about AEE, but now that the AmIAQ Council has 3,200 members, it's time to do our own certification."
The AmIAQ Council's Web site states that those already holding the CIAQP designation may "grandfather" into the CIAQC certification "at no cost (free) during the remainder of their current certification period." It is the same message presented earlier with the CIAQT/CIAQI certifications.
Thumann responded to this, saying, "Obviously, he has his own certification program, and if he says that he wants to 'grandfather' our people into their certifications, that's his prerogative. But we at AEE don't endorse or recognize those certifications."

Replacing "Replaced"
One of the biggest issues is the use of the word "replaced" in the American Indoor Air Quality Council's promotional materials about its new certifications. When asked why the council chose to say the CIAQI and CIAQC replaced the CIAQT and CIAQP, respectively, Charlie Wiles admitted his organization could have used a better word.
"Maybe I should have said 'instead of,'" he said. "But from my side of the table, we're not going to do them [CIAQT and CIAQP]; we're going to do these [CIAQI and CIAQC]."
On the other side of the table, the Association of Energy Engineers will continue to offer CIAQP through Chelsea Group. Al Thumann said, "The Association of Energy Engineers has an active CIAQP training and certification program. Any individuals who claim there is a replacement are doing so for their own benefits, and it's not going to impact us in any way."
"I'm extremely disappointed that they chose to introduce another certification program," said Benda. "It adds confusion to the marketplace. I don't think they've clarified most of the certified programs they offer as far as how they fit into the certification universe. I'm just very concerned with the very large number of certifications that have become available; this only adds to the marketplace confusion."
Wiles responded to this comment, first saying that he holds three certifications from AEE alone. "Each one of the certifications is specific to the discipline that it's meant for," he said. "We keep trying to raise the bar. We're trying desperately to make ours more meaningful."

Closed- vs. Open-book
One of the main differences between the CIAQP and CIAQC examinations is whether those being tested should have access to their textbooks during the examination period. The Certified Indoor Air Quality Professional exam has always been and will remain an open-book test, while a major marketing point of the Certified Indoor Air Quality Consultant program is that its exam will be closed-book.
This detail takes center stage due to the attention given it in the American Indoor Air Quality Council's promotional materials about the CIAQC program. In addition, the council's Web site states that the open- vs. closed-book issue was one item on which AEE had not been willing to budge.
The existence of this issue was news to George Benda. "Charlie never asked us to do that. Charlie never once raised that to the board," he said. "There was no contact as to contributing that to the program."
Responding to the issue itself in interviews, the side in favor of open-book exams faced the side in favor of closed-book exams. Al Thumann said that AEE's open-book tests stress "how to solve a problem through the proper reference books."
He said that although memory is never an issue with the CIAQP exam, memory seems to be an advantage in the closed-book exams. "Those are modeled after what I would call curriculums in schools," Thumann said.
"Ours is not a school program." He said the types of questions would differ as a result. For instance, Thumann said his own exam might ask for information about handling carbon monoxide, whereas a test based on memorization might be more prone to ask for the chemical equation for carbon monoxide.
Benda agreed, saying memorization is not part of being an IAQ professional. "The ability to memorize a set of equations and facts is not a prerequisite in that examination or in that field or arena," he said. "It's our belief, given the nature of the material, that the skill a professional needs is the ability to go to a bookshelf and know which book to use."
Benda added that the CIAQP is geared toward facility managers and that the issue is applying skills. "They have a million things on their mind other than indoor air quality because of the nature of their job," Benda said. "Their gut reaction is the right reaction, and they know where to turn to for the specific information that applies to the situation."
On the other side of the issue, Wiles defended the AmIAQ Council's decision to offer closed-book examinations.
"I don't believe attorneys are interested in whether or not you are able to look up an answer in a book," he said. "I believe that they're interested in the knowledge and experience you possess."
This quote given over the telephone in a one-on-one interview almost nearly matched a statement on the AmIAQ Council's Web site. There, Wiles is quoted as saying, "Attorneys believe it is much more important to be tested on one's knowledge than on one's ability to look something up in an open-book examination."
Responding to this quote, Benda said, "The attorneys may believe that, but the people who actually do the work know that there's more to knowledge than memorization."
But then again, Wiles gave no indication that his examinations would be about sheer memorization or knowing the chemical equation for carbon monoxide. To the contrary, he said, "Our examinations are not directed toward something that would have to be looked up in a table, or something that would require a reference material to be in front of you."
"For several years, we have been revising and updating the CIAQP instruction program and the exam, using 'performance-based learning' principles," said Benda. "We have set the examination question set on the basis of demonstrating that a successful participant has acquired, through training and experience, the skills that an IAQ professional needs to have. We hope that people who hire CIAQP holders know the skill set they are hiring."

Certification For Whom
Consumers and consultants alike trying to determine which IAQ certification is most meaningful are likely to ask what each program is intended to deliver. AEE says the CIAQP program was intended primarily for facilities personnel, whereas AMIAQ traditionally marketed the program to IAQ professionals who make a living investigating and solving IAQ complaints.
According to Thumann, CIAQP will continue to be a program that is geared toward facilities management and operational staff.
George Benda's Chelsea Group has recently been approved as a course provider for the Indoor Air Quality Association, an organization with certification programs that compete with those of AmIAQ. Chelsea Group will be offering IAQA's Certified Indoor Environmentalist program several times in 2003.
CIE is designed for IAQ professionals, although IAQA officials say the CIE course would provide a facilities management person with an excellent IAQ education.
 

The offices of Indoor Environment Communications have moved to a state-of-the-art office building in Rockville, Maryland. IE Communications is the publisher of this newspaper, and also provides association management services to the non-profit Indoor Air Quality Association (IAQA).
The building consists of 6,200 square feet of office space. "The move to a larger, more technologically advanced facility will assist our growing organization's staff deliver excellent customer service," said David Bazzoli, Office Manager of IE Communications. The new address is 12339 Carroll Avenue, Rockville, MD 20852.
IAQA, whose headquarters office is run by IE Communications under contract, will occupy more than 3,000 square feet of the office space. "We're glad to see our management company upgrade their facility," said Tom Yacobellis, IAQA President. "The company has invested heavily in new office equipment and systems in the last year, and our members are benefiting with better service and expanded resources," he added.
Both IE Communications and IAQA had to change their phone numbers with the move. The new IE Communications phone and fax numbers are 301-230-9606 (phone) and 301-230-9631 (fax). The new IAQA phone and fax numbers are 301-231-8388 (phone) and 301-231-8321 (fax).
In conjunction with their move the IE Communications and IAQA office will be closed on Friday, January 10 and Monday, January 13.
They resume normal operations at their new home on January 14, 2003.
The thirty-five year old, three-story building that IE Communications and IAQA will occupy was purchased by Fellman Holdings, LLC in December. Fellman Holdings, LLC is owned by Glenn Fellman, who is also the owner of IE Communications and serves as Executive Director of IAQA.

The company that built the 127 homes of a subdivision in Boise, Idaho, faces multiple suits from homeowners who contend the company did not disclose knowledge of an existing indoor air quality problem in properties when they were sold.
In a class-action suit filed Dec. 9, a group of three homeowners accuse Hubble Homes of ignoring obvious drainage issues within the Leo's Rosecreek subdivision, leaving the homeowners with stagnant water and mold and fungus growth. One of the homeowners attributes two years of health problems to the contaminants in her home.
Two separate class-action suits were filed in November and December 2002, and at least two individual cases filed in June 2002 by subdivision homeowners are still pending. One further individual case brought by homeowners against Hubble dated back to November 2000.
The latest suit drew a fair amount of media attention in Idaho due to the high profile of its lead counsel, Steve Berman, a nationally recognized expert in class action. He helped to recover losses from Enron employees' retirement funds, and his cases against the tobacco industry on behalf of 14 states resulted in the largest settlement in the history of legislation.
Berman's litigation against Hubble hinges on groundwater issues in the subdivision. "We intend to show that the defendants knew there was a groundwater issue with the development area but ignored the issues," he stated in a press release.
"The damage is so profound that the residents are concerned with the health and well-being of their family and have literally packed up and moved out," Berman continued. "These people concluded it is better to move out than live in a human-sized petri dish full of fungus and mold."
Plaintiff Celeste Richardson, who purchased her home from Hubble in May 2000, commented to Boise television stations and Idaho's Statesman newspaper that the mold growth accounted for her two years of suffering from bronchitis, severe sinus problems and migraine headaches. "I've missed a lot of work in these two years," she told the newspaper.

Answering Why
Hubble Homes, which has operations in both Idaho and Utah, used the same newspaper to respond to the allegations. Special Projects Coordinator Wayne Forrey was quoted in the Statesman Dec. 12, saying that homeowners' landscaping and over-irrigation are to blame.
He said landscaping can alter the slope of new homes' yards so that water cannot properly escape from the homeowners' foundation. The excess surface water would then seep into crawlspaces in the homes, Forrey continued.
The overgenerous watering of lawns was another factor in the standing water beneath people's homes Forrey listed. "If you overwater, it can happen," he said.
Homeowner Richardson discounted that as a factor in her case. "I run my sprinklers about five minutes a day when I run them," she commented to Statesman writer Michael Journee. Richardson's attorney, Philip Gordon, agreed with her client, remarking, "We think the surface-water argument is a red herring. If we hadn't seen these problems year round, there might be something to that."
However, comments from Idaho's chief soil scientist upheld Forrey's response to the suit. Soil expert Dave Hoover said in a Dec. 19 report on Idaho's NewsChannel 7 that much of the area in the subdivision lies in a layer of claylike soil that does not allow water through. Where this type of thick, impervious soil called hardpan exists, water cannot go into the soil, Hoover and Forrey said.
Instead, where it goes from there could be anybody's guess, they said. "Water movement is so variable, that I don't know that I could have predicted just how it would have come out or where it might have come out," said Hoover.

Early Sale
Records from the Boise City Council show that in 1998, Hubble Homes, then known as Cherry Creek Homes, was aware of the potential for a water problem. The plaintiffs in the December 2002 class action "believe that [the company] did not provide for adequate drainage of individual lots and/or foundations." To support this statement, the plaintiffs cite drainage maps they see as "questionable" and a haphazard county inspection that took place in 2001.
Cherry Creek Homes began selling lots in the subdivision around June 15, 1998, according to the latest class-action suit. However, it notes that this date precedes the county's acceptance of an application for a preliminary plat, a proposed map of the subdivision including streets and sanitation. Records from the City of Boise indicate that the preliminary plat for the subdivision was recorded later that month but not approved until August 25, 1998.
Under Hubble's two-year warranty program, the company will take care of any defects reported by homeowners during the first two years of ownership. It was during the first two years of homeownership that several Leo's Rosecreek residents complained of standing water and mold and fungus growth in their homes, their lawyers say.
And during that same time, new sales of homes in the subdivision continued, undisturbed, they add. "We will introduce evidence that Hubble continued to tout new homes to buyers even when complaints regarding the groundwater were flooding in," the press release accompanying the most recent class-action suit states.
It also mentions Hubble's marketing slogan, which includes the words, "Quality built designer homes." Further irony is evidenced in a mission statement at Hubble's Web site: "to provide excellent value and cost effective homes, which meet or exceed the expectations of our customers."

Healthcare facilities, unlike any other public, private, governmental or quasi-governmental entity present probably the most difficult challenge for the indoor air quality professional. As scientific research advances to overtake the runaway train of personal injury litigation related to indoor air quality (especially mold exposure), one overriding consideration is emerging.
While everyone believes exposure to airborne contaminants is unhealthy and inadvisable, the extent to which these contaminants effect individuals with normally functioning immune systems is still the subject of intense and sometimes emotional debate. One thing all sides can agree on is this: Indoor airborne contaminants and irritants, whether biological, chemical, man-made or naturally-occurring, have the most profound effect on the young, elderly, and those with weakened or compromised immune systems ("at-risk individuals").
Not only do healthcare facilities, by definition, have the highest concentration of these "at-risk individuals," but they also offer unique considerations for both the administrators who oversee them and the contractors who perform professional services on their premises.
The purpose of this article is threefold: (1) to provide the reader with an overall view of the legal regulations and restrictions that govern indoor air quality in hospitals; (2) to provide real-life examples of how seasoned industry professionals deal with the unique problems posed by construction and/or remediation in hospitals; and (3) through the experiences of these industry professionals, to provide legal advice as to how contractors may best protect themselves in these sensitive environments.

Unique Environment
Hospitals present unique regulatory environments as they are jointly regulated by federal and state legislative and administrative agencies and professional agencies or societies. An exhaustive listing of these agencies is beyond the scope of this article. However, there are several principal players in the hospital IAQ arena.
The primary federal regulatory agency active in the IAQ field in hospitals is the Occupational Safety and Health Administration. OSHA regulates air contaminants under the Code of Federal Regulations, 29 CFR §1910.1000. Several airborne contaminants, such as formaldehyde, glutaraldehyde, xylene, ethylene oxide, cadmium and lead, are regulated by OSHA under 29 CFR §1910.
Specific OSHA regulations applying to hospitals (among other non-industrial work environments) are currently under review and could be enacted within the near future. Until the OSHA guidelines, regulations or standards are promulgated and become subject to enforcement, we will have to look to other guidelines and standards in the industry for IAQ guidance.
The second player in the IAQ hospital field is the National Institute for Occupational Safety and Health Administration. NIOSH has no promulgated, enforceable, regulatory standards. However, it has established recommended exposure levels, or RELs, for such common hospital air contaminants as nitrous oxide and halogenated waste anesthesia gases. It should be noted that compliance with these RELs is not mandatory, but it has become at least common or recommended industry practice.
In addition to these two governmental administrative agencies, there are three professional organizations that are players in the hospital IAQ game. The American Conference of Governmental Industrial Hygienists is a respected professional society that has set threshold limit values, or TLVs, for certain IAQ contaminants, namely glutaraldehyde, xylene, ethylene oxide and formaldehyde. Similar to NIOSH RELs, these TLVs are the levels under which workers can be exposed for an eight-hour workday and a 40-hour workweek without appreciable harm. These TLVs are not legal or enforceable, but many industry professionals consider them highly informative and useful.
The second professional organization involved in IAQ in hospitals is the Joint Commission on Accreditation of Health Care Organizations. This professional organization is charged with the duty of examining and accrediting hospital facilities. As of January 1, 2001, healthcare facilities accredited by JCAHO must have a management program in place "to reduce the potential for organizational-acquired illness." The organization further established Standard EC 1.7 to hold healthcare facilities responsible for managing pathogenic biological agents in cooling towers, domestic hot water and other aerosolizing water systems.
In order to assess accurate compliance with these standards, it is recommended that healthcare facilities conduct or develop management risk assessment plans to gather information, inspect conditions and handle or manage these risk factors. Once risk assessment is complete, a management plan should be developed to ensure compliance with JCAHO EC 1.7.
In addition to these risk assessment plans, hospitals should undertake additional steps in assessing and managing airborne contaminants. The primary reason for this lies in the fact that nearly 90,000 individuals die each year from nosocomial infections. These are infections contracted by a patient while he or she resides in the hospital environment.
JCAHO further requires that hospitals establish stringent Infection Control Risk Assessments, or ICRAs, for accreditation compliance purposes. The American Institute of Architects in its Guidelines for Design and Construction of Hospital and Health Care Facilities requires ICRAs to be performed for every healthcare construction project. ICRAs primarily assess the risk to patients from construction related activities, disruptions, noise and contamination. In addition to the obvious application to individuals or organizations performing construction activities at a hospital, non-construction contractors such as design professionals, engineers, architects, painters or other individuals or entities performing services that may produce noise, destruction or potential for contamination in a hospital must also develop and follow ICRA protocols.
These plans include review of types of work to be performed by each and every contractor on the premises and what effect that work will have on production of airborne contaminants, noise, odors and/or cross-contamination. Not only must contractors be aware of ICRA compliance, but hospitals should also insert ICRA compliance provisions into any contract documents they enter into with a third-party service provider. Further, hospitals should undertake measures to ensure compliance with these ICRA requirements with the ultimate purpose being to minimize disturbance, contamination and ultimately, nosocomial infections.

Practical Concerns
In order to appreciate the complexity of the issue and to understand the application of these regulatory requirements for the contractors in the field, I interviewed three individuals who together have many years of experience working in hospitals and other healthcare-related facilities.
I initially spoke with Jon Heidelberg of Lamunyon Cleaning and Restoration. Having worked in numerous hospitals, healthcare clinics and offices, he is acutely aware of the special needs inherent in working in these tightly controlled facilities. Heidelberg says he conducts a critical evaluation of every job prior to entering into a contractual agreement with a healthcare facility.
After meeting with the hospital board and learning of its expectations, plans and goals, he is better able to analyze the scope of work to be performed. He insists on full disclosure from all parties and clean and unfettered lines of communication. He states, "Be prepared to walk away from any job where you feel there is either unreasonable or unclear expectations from any party." I agree with him.
Furthermore, he advocates not splitting a job up into multiple components with multiple bids, contractors and service providers. It will ensure a higher quality product if one contractor performs the entire job. From a legal perspective, this is a sound practice, although sometimes it may increase the up-front or resulting costs of a project.
For example, with multiple service providers and overlapping responsibilities, there may be multiple parties liable in the event of a mistake. Who bears the legal responsibility regarding a situation when there are multiple responsible parties? Who provides an ongoing warranty covering labor and materials for a project having multiple interrelated components?
As a possible solution to this risk-sharing problem, I recommend the establishment of a "matrix" of potentially responsible parties who have agreed to share the liability should litigation ensue. For a more complete discussion of these principles, please see my June 2002 article in IE Connections, "Legal Solutions to Real Life Problems."
Other important considerations to Heidelberg are (1) utilizing the most highly trained and experienced permanent staff in these conditions; (2) a daily meeting is held to plan the construction activities and address any concerns or potential problems; (3) direct and detailed involvement of a hospital "liaison" who works between the contractor and the hospital board to ensure smooth operation; (4) critical maintenance of all containment barriers to insure that the hospital is kept functioning in a safe manner; (5) a low profile must be maintained with separate entrances and exits for all personnel; (6) as much time is spent in planning as in execution of the project; (7) a third-party, independent evaluation should be performed throughout the process to monitor compliance and ensure clearance; and (8) the highest quality equipment available should be utilized and properly maintained.
I also interviewed Charlie Cook of BMS Catastrophe Inc. to get his view on issues he has encountered while working in the hospital environment. He has encountered IAQ problems in hospitals and healthcare facilities all over the world. Not surprisingly, Cook independently echoed all of the same considerations voiced by Heidelberg. Cook's primary focus is on communication between the parties during the remediation and/or clean up.
The critical factor to the successful accomplishment of all goals is planning. He advocates use of a pre-loss standby agreement or some type of emergency response agreement between the service provider and the healthcare facility. Cook handled a large portion of the clean up at the Houston Medical Center as a result of floodwaters generated by Tropical Storm Allison in June 2001. There were a large number of healthcare facilities stricken by this unforeseen flooding event, and only those healthcare facilities that had pre-loss standby agreements in place were able to be serviced in a rapid and efficient manner. I also recommend that hospital administrators enter into these pre-loss agreements for a multitude of reasons.
In a pre-loss contractual situation, the parties are better able to negotiate and plan for important financial and legal issues in a somewhat relaxed atmosphere without any time constraints. For example, (1) the parties can have their legal counsel review and modify any contractual agreements up front; (2) response priorities can be set out by the customer; (3) critical information can be provided greatly facilitating response time and effectiveness; (4) mechanisms can be put into place to handle the loss discretely; (5) insurance companies, both primary and excess, can be involved in the pre-loss process to ensure their approval; (6) annual updates and reviews of the documents may be undertaken with specific care given to any facility modifications; (7) the ability to bring in other subcontractors, e.g., document retrieval experts, can be built into the contract; and (8) financial costs may be negotiated up front at a time when neither party is in an unfair bargaining position. From a legal perspective, these agreements should be non-binding, evergreen and somewhat flexible. In the event that the hospital and/or contractor is sued as a result of some action or omission during the crisis, these agreements can be provided as a good defensive strategy for both the healthcare provider and the contractor.
The last individual I interviewed, Wynn White, is a professional engineer with many years of experience resolving environmental and indoor air quality problems in hospitals. He has been called upon as a consultant on healthcare projects to manage indoor air contaminants and irritants in hospitals, including asbestos, chemicals, moisture and mold.
White preaches efficiency and effectiveness in design and operation of the facility to control production, spread and elimination of contaminants. As I have heard him say many times, "There's no right way to do a wrong thing." His primary areas of concern for hospitals have been their air handling design and choice of building materials. Without the proper air pressure and humidity and temperature controls in place, many IAQ problems will be exacerbated. White also advocates the avoidance of deferred maintenance and the implementation of integrated mold and moisture management and assessment plans by the hospital administration.
Furthermore, a detailed and extensive peer review should be made each time construction is undertaken at a healthcare facility. For example, the change in use in one portion of the hospital can create a multitude of IAQ problems. The simple mistake of placing a cold air diffuser directly in front of an external door ensures that cold air immediately meets warm air thereby creating conditions conducive to moisture condensation and resulting mold growth.

Future Developments
As a result of the continuing and acute interest in indoor air quality (particularly mold contamination) many government agencies have been put into high gear to come up with standards and/or solutions to this problem. Thus, OSHA has now proposed an indoor air quality rule, Congress has introduced a myriad of legislative enactments to address IAQ issues, the EPA has implemented a number of guidelines to address certain IAQ issues in schools, commercial buildings and residences, many states have enacted statutes designed to address these issues and many private professional organizations have created recommended guidelines and standards.
Even though hospitals can be a "minefield" of IAQ pitfalls for the unwary, there are steps that can be taken to minimize legal exposure. I advocate: (1) creation of risk assessment management plans; (2) execution of pre-loss standby agreements; (3) selection of the most highly qualified individuals by training or experience to conduct the construction and/or remediation activities; (4) regular view of all areas of the hospital which are particularly susceptible to nosocomial infections; and (5) review of any change in usage or modification to the equipment or facilities which might effect indoor air quality. With these factors in mind, hospital administrators and contractors can minimize their ultimate legal liability in the event of litigation.

On that tragic day in September 2001 when I lost so many of my brother firefighters and police officers, one of the first things called to duty were dogs to search for any survivors. Immediately following that, the dogs were again called to service: to search our airports and seaports for explosives. They are still actively doing so today for homeland security.
Now rewind the clock five years before September when the insurance industry approached me with a question: If dogs can sniff out bombs, people, drugs and arson, then why not mold? With the question posed, we set out to prove that we could train the dogs to detect mold.
Along the way, help was needed in various expertises. For the chemist aspect we referred to chief forensic chemist Niles Bashaw of Innovative Applied Science Laboratory, in Tampa, Fla. For the microbiology/industrial hygienist, we used Michael Williamson of Apollo Environmental Inc., in Gibsonton, Fla. For veterinary and research support, we utilized Dr. Larry Myers of Auburn University, in Auburn, Ala.
The research has shown that whether you use cocaine or peanut butter, the dog's sense of smell is in the parts-per-trillion range. To put that into perspective, the dogs are able to smell an amount considerably smaller than a baby's teardrop.
Armed with the support of the experts, we began training the first test dogs with a few mold odors. We decided to use only a couple of odors, to make sure the dogs would be able to identify the molds and, more importantly, to make sure the dogs could find molds hidden in buildings. Once we knew the dogs could find the hidden mold within buildings and homes, we set out to fine-tune the dogs' abilities and add additional odors.
Our further research showed that there were items the dogs needed to be scent discriminated against. Scent discrimination is the art of teaching the dog not to alert to similar odors, not to alert in many places, and to be able to pinpoint and alert at the source of mold. The odors the dogs are scent discriminated against are odors that the dogs would commonly come in contact with when searching for mold. Our research also showed that the dogs could be used to search various types of buildings and structures, such as homes, motels, schools, businesses, cars, planes and ships. We also learned that they could find hidden mold with similar accuracy as the termite dogs had. These areas included behind concrete block walls, drywall, bricks, wood siding and concrete, as well as under the floors in basements and crawlspace-type construction.
We began training for more than 18 different types of mold. As amazing as this sounds, finding hidden mold is not as hard as finding arson, bombs or drugs. For example, arson dogs must alert to more than 30 different types of accelerants and must be able to do so after an arsonist has poured gasoline in a building, the building has burned to the ground, the firefighters have put thousands of gallons of water on the fire, and all of the the burned items are masking the odor of the trace amounts of accelerant left. The dog must then sniff through the ashes and accurately pinpoint the remaining parts per trillion of gasoline left.

No Odor To Mask
Similarly, drug dealers routinely try to hide their drugs by masking the odor with items such as coffee or fabric softener, but still the dogs find it. Mold is not hiding from us; it is just not often visible to the human eye. It is routinely found between the walls, similar to how termites are found; in previous studies, we proved the dogs were capable of finding termites hidden behind walls and underground with a high degree of accuracy. The pest control industry has used the dogs for many years to find termites that would have otherwise gone undetected. The dogs further allow the pest control industry to pinpoint hard to locate areas for more accurate treatment.
The mold industry will greatly benefit from this tool because there are many customers for whom the mold dogs can be utilized, be they attorneys performing litigation or mold remediation companies wanting to pinpoint areas of trouble, allowing for accurate remediation. Additionally, the lending industry will also benefit from having inspections performed prior to the sale of property. The mold inspector can more accurately collect samples and target troubled areas. Finally, the homeowners can receive quicker confirmation and be able to return to their homes quicker.
We were also able to determine that various breeds of dogs could perform the task of finding mold, allowing people to have a choice of the type of dog that they wanted. The research did not differ with gender, but the preferred age range was 1-3 years old. Most of our dogs are obtained through the Humane Society of North Pinellas, located in Clearwater, Fla. This allows us to use dogs that might have been put to sleep or could not find a home. We have successfully trained Labradors, border collies, Aussies, Jack Russells, beagles and several mixtures of these. Most of these dogs are in the hunting or working class. They are best suited for this type of work due to their playful drive and their wiliness to please their owner.
The study further showed that there were pros and cons to all of the different types of dogs. Based on this, I believe that it is best that the trainer, prospective owner/handler, and his or her family work together to pick the best type of dog for them.
The dogs receive 600-1,000 hours of training from the time they come from the humane society to the point that the handler comes to the class. The dogs' training includes minor obedience, odor identification, search patterns, scent discrimination, various types of building search areas, socialization and vehicle rides.
When the handler arrives at the academy, he or she is given the same training and standards as the handler of a drug or bomb dog would receive. This training includes canine handling, search patterns, working in different types of buildings and structures, scent discrimination training, marketing (including dealing with the media) and trade shows. Handlers learn how to maintain their certification. They also learn proper care for the dog, including bathing, grooming and playtime. They are taught canine first aid, canine CPR, sampling techniques and minor obedience as well.

Don't Try This At Home
Though the years, I have met many dog trainers and although most seem to be doing a good job, many of them don't have the qualifications to teach scent work.
With that said, there's a joke about dog trainers that relates to this subject: "If you put two dog trainers in a room, the only thing they will agree to is that a third dog trainer coming into the room knows less than they do."
There are very definite standards and qualifications to be a master trainer, the problem is that the majority of the public does not know of these standards, but rest assured that the courts do.
These standards are not necessary for the local person who trains dog obedience. While I'm not saying it's easy to train a dog in obedience or making light of this training, it's not the same as training a dog for scent work such as drugs, bombs or arson. Unfortunately, many unqualified people attempt to do so, simply because they have been training dog obedience.
To qualify for the court or criminal justice system, I was first trained by the Maine State Police Canine Center, which is one of the oldest established canine training centers in our country. This is the same level of training that the mold dog handler would receive by coming to the Florida Canine Academy. This does not make the individual a trainer in the eyes of the court. You will be certified as a handler.
After a five-year period of time as an active and re-certified annually handler, I qualified to return to the Maine State Police Canine Training Center as an assistant trainer, working under the direction of a master trainer for three additional years.
Finally, I returned again to school and obtained the training necessary to become a master trainer. The final examination consisted of completely training a scent detection dog and handler for review by my peers.

Bill Whitstine, the owner and operator of the Florida Canine Academy, also serves as master trainer. He has been a leader in the field of canine training since 1989 when he became the first person to attend the Maine State Police Canine Academy in Accelerant Detection. Soon, he was Maine's most successful handler, training canine teams to sniff out bombs, drugs, money, weapons, termites, mold and accelerants. His canine partner of 13 years, Villain, was Florida's first accelerant detection dog. Whitstine is the author of the only published book on accelerant detection canines. He was the founding president of the Canine Accelerant Detection Association and the International Termite Detector Dog Association, both international organizations. He has been featured on over nine shows on the Animal Planet and The Discovery Channel. Whitstine is committed to the education of all professionals involved in canine handling. He can be reached by phone at (813) 267-5925 or by e-mail at flfirek9@aol.com.