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Multiple Chemical Sensitivity - Is it a Disability under ADA? by Grace T. Hanson, Mei-Ling Hsieh, Kambiz Khoddam, Monica Lee, Gary Nellesen, Sonya Sevier, Steve Shackelford, and Timothy Takashima, Mount San Antonio College Winter 2011 “Accommodating Students with Disabilities in the Classroom;” course facilitated by Grace T. Hanson, February 2011 (http://elearn.mtsac.edu/ghanson/dspsaccess). I asked my Winter 2011 class to respond to the following: “A good student, whom you have known to have taken several courses in your area, approaches you the second day of class and says that she has chemical sensitivity disorder. She states that you must tell the class they can wear only unscented products. As the instructor, what can and must you consider regarding this request? The following information will help you respond to this question. What is Multiple Chemical Sensitivity Disorder? Multiple Chemical Sensitivity (MCS) is a condition in which a person develops markedly negative reactions to everyday chemical exposure. Sometimes referred to as “chemical sensitivity,” MCS is an extreme sensitivity, or allergic reaction, to any of various chemical compounds present in the normal environment. This condition is said to develop from an exposure or overexposure to a specific chemical or a variety of chemicals in the environment. WebMD explains that this condition is a result of being exposed to a “wide range of chemicals after a major environmental event, such as a chemical spill, or from long-term contact with lowlevels of chemicals, such as in an office with poor ventilation.” The effect of this chemical exposure may be intolerance to even very low levels of exposure to certain chemicals that generally cannot be detected by others in the same immediate area. According to the Disability Opportunity Internetworking and Technology (DO-IT) program at the University of Washington, “Multiple Chemical Sensitivity (MCS) is a disorder triggered by exposure to chemicals in the environment. Like allergies, symptoms tend to come and go with various exposures, although some reactions are delayed. Symptoms typically occur in more than one organ system in the body, such as the nervous system and the lungs. MCS typically impairs many bodily functions, including the nervous system and digestion. It also affects the overall health and well being of those with the disorder. Each individual affected by MCS has a unique set of health problems. Some symptoms of MCS that could impact academic performance include headaches, asthma or breathing problems, memory loss, fatigue, and depression. Students with MCS may experience difficulties with academic requirements such as attendance, fieldwork, test taking, completing assignments, and carrying full course loads” (http://www.washington.edu/doit/Faculty/Strategies/Disability/Other/) . Causes and Symptoms of MCS Wikipedia states that “symptoms may be vague and non-specific, such as nausea, fatigue, and headaches. This has led some to believe that MCS symptoms are due to odor 1 hypersensitivity or are mainly psychological. Regardless of etiology, some people with severe symptoms are disabled as a result” (http://en.wikipedia.org/wiki/Multiple_chemical_sensitivity ). The symptoms as well as the chemical irritants vary from person to person; yet, however affected individuals tend to react the same way to similar triggers. Exposure to the chemical irritant can be via air, food and water, or through the skin. It is clear that multiple senses, as well as organs and bodily systems, may be affected. Symptoms Exposures acute abdominal pain wheezing, asthma, breathlessness, headaches, migraines, vertigo and dizziness rashes,nausea extreme or chronic fatigue & weakness, lethargy concentration & memory loss muscle & joint pains numbness, tingling, twitching sore eyes, ears, nose & throat Multiple Senses alcohol & medications caffeine & food additives raw fuels & engine exhaust new carpet & furnishings paint & renovation materials perfume & scented products pesticides & herbicides solvents & cleaning agents molds smoke poor indoor air quality Organs & Systems hypersensitive to smells photosensitive, blurred vision intolerant of loud noises bothered by abnormal tastes hypersensitive to touch & temperature extremes impaired "senses" of balance, coordination, & concentration Central nervous system Eye, ear, nose, & throat Gastrointestinal Musculoskeletal Peripheral nervous system Respiratory Skin Cardiovascular Neurological Immune Endocrine (Adapted from: http://www.mcsrr.org/factsheets/mcsdisorders.html, and http://ohioline.osu.edu/cd-fact/pdf/0192.pdf, retrieved March 6, 2011). In the classroom environment, such things as felt tip pens, white board markers, other marking pens (including highlighters), chlorine from a nearby swimming pool, perfume and other scented products including aerosol deodorants, after shave lotion, hair spray, perfume in some cosmetics, and nail polish can all be chemical irritants to those with MCS. In areas adjacent to classrooms, other irritants might include asphalt pavement, public restroom deodorizers, and cigar or cigarette smoke. Why is MCS Controversial? 2 MCS is not currently recognized by the American Medical Association, American Academy of Allergy and Immunology, California Medical Association, American College of Physicians, and International Society of Regulatory Toxicology and Pharmacology (http://ohioline.osu.edu/cd-fact/pdf/0192.pdf). There is disagreement within the medical community as to just about every aspect of MCS, including its name. The condition commonly referred to as MCS is also called: Environmental Irritant Syndrome, Acquired Intolerance to Solvents, Immune System Dysregulation, Idiopathic Environmental Intolerances, Multiple Chemical Reactivity, Toxic Response Syndrome, 20th Century Syndrome, Chemical AIDS, Total Allergy Syndrome, Environmental Hypersensitivity, Environmentally Induced Illness, Ecological Illness, Total Allergy Syndrome, Food and Chemical Sensitivity, Sick Building Syndrome, Toxic Carpet Syndrome, Cerebral Allergy, and Allergic Toxemia (http://www.winterbauerdiamond.com/inprint/Doc040629.PDF, retrieved March 6, 2011). Areas of divergence include a comprehensive definition and course of treatment. Differences of opinion can be attributed to symptoms varying greatly from one patient to the next; some treatments fail to work at all. Additionally, symptoms that have been labeled as those of MCS are common to other illnesses as well. Finally, studies in MCS show about 2/3 of those with Chronic Fatigue Syndrome (CFS) and Fibromyalgia also have MCS (and vice versa), as do half of those with allergies. Like CFS, MCS is more common in women and can start at any age, but usually begins in late puberty to mid-life. (http://www.mcsrr.org/factsheets/mcsdisorders.html, retrieved March 6, 2011). In a paper entitled “Multiple Chemical Sensitivity: Toxicological Questions and Mechanisms,” published in 2009, professor Martin L. Pall argues that multiple chemical sensitivity (MCS) “is a stunningly common disease, even more common than diabetes...In the U.S., approximately 3.5% of the population is affected by severe MCS, with much larger numbers, at least 12% of the population, being moderately affected. MCS is, therefore, a very large international disease epidemic with major implications in terms of public health” (http://www.mcs-international.org/news_prof_pall_mcs.html ). Although MCS is very controversial, both the U. S. Department of Housing and Urban Development and the Social Security Administration have recognized MCS as a disability. Many state agencies help individuals with MCS by providing assistance with homemakers, counselors, and many other crucial. Individuals with MCS have won Workers' Compensation cases. A human rights lawsuit in Pennsylvania established the right of an individual with MCS to a safe living space in subsidized housing. Both the Maryland State Legislature and New Jersey State Department of Health have officially commissioned comprehensive studies of MCS (http://www.lectlaw.com/filesh/csl01.htm. According to J. E. Heimlich (2008) of Ohio State University, some of the indicators that MCS diagnosis include: The symptoms are reproducible with repeated exposure; the condition is chronic, both high and low levels of exposure may result in the same symptoms; the symptoms improve or resolve completely when the triggers are removed; responses often occur to unrelated substances; and the symptoms attack more than one organ or area of the body (http://ohioline.osu.edu/cd-fact/pdf/0192.pdf). To provide a credible diagnosis of MCS, these indicators should be mentioned in a verification of disability document written by a qualified medical professional. Is MCS a Disability Under the ADA? 3 Prior to the amendments to the Americans with Disabilities Act coming into effect (ADAAA), MCS was slow to become recognized as a disability. A law office web site cited a Detroit case where an employee with MCS won a monetary award and the employer adopted a workplace policy where employees were to refrain from wearing scented products and were no longer allowed to wear colognes, perfumes, scented deodorants, and the like. The court ruled that an allergy to scents can be a disability under ADAAA. More specifically, when an employee has severe symptoms as a result of being exposed to odors or scents, that can be ruled a disability. The interactive process should be conducted privately and individually between employer (or student) and employee (or student). The Jobs Access Network (JAN) provided these question that could be asked in an employment situation. Replace the word “employee” with “student,” and “job” with “school,” and the same questions can be asked in an office of higher education disability services (http://askjan.org/media/mcs.html, retrieved March 6, 2011). 1. 2. 3. 4. What limitations is the employee experiencing? How do these limitations affect the employee and the employee’s job performance? What specific job tasks are problematic as a result of these limitations? What accommodations are available to reduce or eliminate these problems? Are all possible resources being used to determine possible accommodations? 5. Has the employee been consulted regarding possible accommodations? 6. Once accommodations are in place, would it be useful to meet with the employee to evaluate the effectiveness of the accommodations, and to determine whether additional accommodations are needed? 7. Do supervisory personnel and employees need training? (http://askjan.org/media/mcs.html, retrieved March 6, 2011). After asking the general questions, it is a good idea to customize the conversation to the specific disability. In the case of MCS, ask the student if they know what is causing their reaction. Ask the student what accommodations worked in the other classes. Most likely, he/she knows, and it may be a simple exercise in polite conversation to resolve the problem. Even though there might not be a uniform belief regarding the nature of chemical sensitivity, because there has been precedence in Workers’ Compensation claims, tort liability, and regulatory action, disability services should acknowledge MCS as any other disability. Some Classroom Accommodations and Strategies 1. Make sure that the room is well ventilated. 2. If the ventilation system does not work correctly or cannot do the job, see if a better, more ventilated room is available. 3. If the offending chemical is cigarette smoke, ask for help from public safety in enforcing state law related to smoking in proximity of a room or to enforce non-smoking campus policies. 4. If the offending chemical is unknown, provide an alternate section, if available, as the offending chemical may be brought in by another student (perfume, after shave, or deodorant). 5. If the offending chemical is part of the curriculum, see if there is an alternate assignment, or a different class section. 4 6. Provide on line classes as alternatives, if available. 7. Provide technology, such as assistive listening devices or teleconferencing, and have the student “tune in” from another room. 8. At this point, it is unclear as to what definitive action could be taken when the rights of individuals to access learning in a classroom conflict with the rights of others to wear scents. However, it is reasonable to inform the class of the situation, protecting the affected student’s confidentiality. An incidence of MCS can be used as a teachable moment. 9. Provide a classroom that has working windows. 10. Although in some classroom buildings, the windows do not open, allow the student to sit near the door to provide the opportunity to quickly exit if exposure occurs. 11. Consider flexible attendance due to the unpredictable nature of the disorder. 12. Request alternative test accommodation through the campus disability office. 13. Given the chemical, plastics, and petroleum-based culture that we all live in, and short of total isolation, it is a practical impossibility to insulate a student from all possible offending chemicals, perfumes, and fragrances. Conclusion The public has been misled into thinking that perfumes and scented everyday products are perfectly safe. Perfumes and scented products are made of hundreds of chemicals known for their neurotoxicity. Unfortunately, the majority of consumers are uneducated about the health risks; the real dangers of chemicals used in synthetic fragrances, in the same way that average non-smokers were unaware of the risks of second-hand smoke (http://www.americanchronicle.com/articles/view/149122). It is likely that we all have a certain level of sensitivity to certain chemicals. The actual test as to whether or not MCS should be considered a disability protected under the ADA relies on the severity of one’s symptoms. Do the symptoms cause a major life barrier? Accommodation is needed for a student who has appropriate documentation of the condition and who can show that the symptoms cause a major life barrier. Additionally, students appreciate any efforts an instructor takes on his/her behalf. Given the possible psychosomatic aspects of this disorder, there may be a beneficial “Hawthorne Effect” if the student perceives that something is being done to make their classroom experience more manageable. Additional Resources http://www.chemicalinjury.net/ http://www.beyondpesticides.org/infoservices/pesticidesandyou/Fall08/ChemicalSensitivity.pdf http://www.chemicalsensitivityfoundation.org/ www.multiplechemicalsensitivity.org www.mcs-global.org www.mcs-america.org www.niehs.nih.gov/external/faq/mcss.htm www.mcsrr.org 5