Doctors working near Cadia Hill goldmine in central west New South Wales have been advised not to test patients for heavy metals unless they have symptoms of toxicity or there is a clear and known source of exposure.
In a webinar for local doctors on 14 June, NSW Health advised against conducting blanket screening of concerned community members and said there was no clear exposure pathway of toxic dust from the mine which would indicate testing was necessary.
But the advice has disturbed some residents, who say they felt their concerns were being dismissed.
The Cadia Hill goldmine is under investigation by the NSW Environment Protection Authority after community testing of rainwater tanks which found some contained high levels of heavy metals. Subsequent water testing conducted by the NSW public health team, which tested water as it came out of the kitchen tap, has not returned any unsafe results.
Last week the EPA ordered the mine to take immediate action or face further regulatory action over “completely unacceptable” levels of air pollution, after testing revealed it was emitting more than 11 times the regulatory limit of dust containing heavy metals.
A local nurse and mother of two, who asked to remain anonymous, told Guardian Australia that she had been “strongly discouraged” from getting her blood tested by a local GP who had attended the webinar, and told her she had been advised not to order tests unless people had “symptoms of heavy metal poisoning”.
Her GP then gave her a printed copy of information about the EPA investigation.
“[The GP] said, ‘Even if you had high metals, we probably wouldn’t treat you in any way,’” the nurse told Guardian Australia. “But that’s not the reason why I was there. The reason why I was there is I want to know if I’ve got high metals in my blood because I’ve been on a farm [not far from the mine] for 11 years and it’s an accumulative thing.”
The nurse said she had decided to book the GP appointment after learning that her former neighbour, who lives 500m from her old house, had his rainwater tank tested for heavy metals and the results had been “well above the safe limits”.
She said the GP had agreed to order the test after she repeated the request but she was concerned that other community members who weren’t as insistent might be discouraged.
“If I’ve got to push and push and push to have something done, and I’m discouraged the whole way through and my concerns are disregarded, then what does that say for the people who have no medical knowledge and are easily persuaded?”
NSW Health said it was working closely with the EPA, had convened an expert panel that included toxicologists and water quality experts to give advice, and had been providing support to GPs responding to residents’ concerns. A spokesperson told Guardian Australia NSW Health had provided no direct instructions to local health professionals, “including about which metals to test for”.
“In support of the investigation, NSW Health recently held a webinar discussion with local general practitioners to provide support, education and share the advice from the NSW Health Expert Panel to ensure they have the best available evidence and guidance to support them in assessing and managing their patients’ health concerns,” the spokesperson said. “General practitioners make their own clinical judgements about their patients, and what testing is in the patient’s best interest.”
The briefing included a caution against increasing fear in the community while also saying NSW Health was concerned and would act on EPA data.
“The discussions with local health professionals covered the complexity of testing and the individual circumstances, along with who best to seek advice from if they had any questions,” the spokesperson said.
The Greens MLC Sue Higginson said she had heard community concerns about the advice to GPs after attending a public meeting called by the Central West Environment Council on 17 June.
The webinar had “clearly created some confusion”, Higginson said.
A Sydney University researcher, Prof Rachel Codd, said determining whether a patient had heavy metal poisoning could be difficult as “the symptoms can be quite diffuse”.
Lead toxicity alone could present with a range of symptoms.
“Lead in blood has a half-life of about 40 days,” she said. “Repeated exposure can result in accumulation in bone, where the half-life increases to many years.
“You might get some nausea and vomiting, vagueness and tiredness and shortness of breath. So they’re really quite generic. You might not necessarily immediately think, ‘Hey, I wonder if these feelings are because I’ve been exposed to some toxic metals.’”
The Australian Medical Association’s NSW president, Dr Michael Bonning, said the health department’s advice “puts GPs in a difficult situation”.
“Many common presentations of heavy metal chronic exposure can come with some fairly general symptoms,” he said. “Abdominal pain, constipation, fatigue – those are all things that we see on a very regular basis in general practice.”
He called on NSW Health to provide more clarity around the advice, “so that the community and through them the general practitioners and other health providers aren’t in a position where they’re having to make decisions of unknown significance on who to test and who not to test”.
“We have a responsibility as a community to protect the health of people around us from systemic risks or threats,” he said.
