Cleaning Chemical Exposure
This case study recounts the circumstances surrounding a woman's claims that exposure
to a chemical stripping agent caused burns, infection and damage to her immune system.
The outcome illustrates the importance of validating claims against medical history
and assessing toxicological factors according to the peer-reviewed literature to
establish reasonable toxicological certainty.
A woman was stocking vending machines as part of her job duties when she slipped
and fell on a floor that was in the process of being refinished with the use of
a chemical wax stripper. The plaintiff reported sustaining chemical burns over a
large portion of her body from the stripping product even after spending 20 minutes
rinsing off in the shower immediately following her fall. She also alleged that
the burns caused her to develop an infectious condition known as methicillin-resistant
Staphylococcus aureus (MRSA) due to damage to her immune system.
In addition, she reported a swollen eye that she believed to be related to
this event. Plaintiff subsequently brought a lawsuit against the floor refinishing
Suspicious Circumstances Cast Doubt on Claims
A careful review of medical records revealed inconsistencies within the plaintiff's
story. Plaintiff demonstrated an extensive medical history of skin rashes, blistering,
cellulitis and frequent MRSA infections that pre-dated her alleged exposure. Additionally,
statements from plaintiff's co-workers revealed that she had been seen intentionally
injuring herself by repeatedly sticking her own fingernail in her eye.
Toxic Exposure or Munchausen Syndrome?
Dr. Sawyer and an independent medical examiner opined that there was neither permanent
impairment of the plaintiff's skin following her exposure, nor was there any reason
to believe that her immune system was permanently damaged or compromised by exposure
to the chemical stripping product. In fact, Munchausen syndrome (a mental illness
in which a person acts as if he or she has a physical or mental disorder when, in
truth, the symptoms are faked or self-inflicted) was considered to be the cause.
The conclusion was highly consistent with plaintiff's extensive history of skin
rashes, self-induced dermatological conditions, hospitalizations and the reported
self-mutilation to her eye.
Factitious disorder (FD) is a general category covering a group of mental disturbances
in which patients intentionally act physically or mentally ill.1
Munchausen's syndrome was named after Karl Frederick Von Munchausen, a German Cavalry
officer who was well known for exaggerating his adventures and who became famous
after a collection of his tales was published. Factitious presentations have been
described all over the world, in every medical specialty and in every age group,
yet by its very nature factitious disorder is difficult to study. There is, therefore,
a dearth of evidence in the literature relating to epidemiology and etiology.2
However, there is a wealth of study evidence relating to the particular chemicals
in the stripping product and their effects on humans. Dr. Sawyer cited a long-standing
study in which various concentrations of sodium hydroxide were applied to the forearms
of human volunteers.3 Results of the controlled study
revealed that sodium hydroxide produced reactions after 15-180 minutes. Thus, if
the plaintiff had been harmed by her exposure to the diluted stripping product,
the initial symptoms (erythema) would have been present during the examination with
her physician on the same day. Furthermore, her "burns" would have been
evident within hours (or at most a day later). However, medical records revealed
that the plaintiff did not report any skin conditions until 22 days after the incident
occurred. Additionally, the concentrations applied during the controlled study were
significantly stronger than the concentration in the diluted stripping product to
which plaintiff was allegedly exposed.
Dr. Sawyer was able to provide conclusive evidence that the diluted chemical ingredients
were insufficient to have caused plaintiff's reported injuries. Furthermore, even
if the chemical components of the stripping product had been undiluted, they would
have caused skin symptoms to occur within an hour or less. However, plaintiff's
first indication of any dermatological issues (as documented in the medical records)
occurred far beyond the required time-frame to be linked to the chemical stripper.
In addition, the stripping product had been diluted with water by a factor of five,
which further reduced any possibility of dermatological impact.
As a result of Dr. Sawyer's toxicological investigation, the case settled for a
very minimal amount. Psychological aspects aside, Dr. Sawyer was able to demonstrate
that the plaintiff's claims were fundamentally unfounded on a toxicological basis.
(Disclaimer: Toxicology case studies are impartial and objective summaries of toxicological
matters in which TCAS was retained for the purpose of assessing health-based
factors which, in some cases, led to a determination of causation. No names or identifying
information have been provided due to privacy and legal considerations. In the above
matter, Dr. Sawyer was retained by defendant.)
Notes and References
- Kamil et. al., "Munchausen's Syndrome and Other Factitious Disorders in Children," U.S. National Library of Medicine, National Institute of Health, 2006.
- Steel R.M., "Factitious Disorder (Munchausen's Syndrome)," U.S. National Library of Medicine, National Institute of Health, 2009.
- Nagao, S., et al., "The effect of sodium hydroxide and hydrochloric acid on human epidermis: An electronmicroscopic study," 1972, Acta Dermato-Venereologica, Vol. 52(1), pp. 11-23.
- Adapted from photo by Jason Britton, Norman, OK