LIBBY, Mont. \u2014 Dozens of feet of tubing connect Gayla Benefield to her oxygen machine so she can walk from room to room inside her home on the picturesque Kootenai River, surrounded by the Cabinet Mountains. <\/p>\n
Like many people who live in this remote town about 80 miles from the U.S.-Canada border, the 81-year-old Benefield has asbestosis<\/a>, or scarring of the lungs from asbestos exposure.<\/p>\n Her father worked at a now-closed mine that supplied most of the world\u2019s vermiculite, a mineral with a wide variety of uses in insulation, fireproofing, and even gardening. The mine closed in 1990, and in 1999, a Seattle Post-Intelligencer investigation<\/a> publicly revealed the connection between the asbestos-contaminated mineral and the increasing number of sick Libby residents.<\/p>\n Benefield remembered the white dust that covered her father\u2019s clothes when he got home from work, and she learned later that the whole family had been exposed to asbestos, a tiny fiber that lodges in the lining of the lungs.<\/p>\n \u201cEventually, that scarring will fully surround your lungs,\u201d Benefield said, \u201cand slowly strangle you.\u201d<\/p>\n The Environmental Protection Agency declared parts of Libby a Superfund site<\/a> in 2002. Seven years later, the agency declared a public health emergency for the town \u2014 a first in U.S. history. A study found that 694 Libby residents had died of an asbestos-related cause from 1979 to 2011. Additionally, health providers in the town of 3,200 estimate that 1 in 10 residents have an asbestos-related illness.<\/p>\n That estimate is from the Center for Asbestos Related Disease<\/a>, or CARD, a 501(c)(3) nonprofit clinic that has provided free lung screenings for locals. The clinic, which operates primarily through U.S. government funding, has screened more than 8,900 people<\/a>. Because asbestos-related disease symptoms can take 30 years or longer to appear, nearly a third of the clinic\u2019s screenings are for new patients, according to a 2024 CARD report.<\/p>\n But now, Libby residents can no longer get that care because a judgment in a lawsuit brought by BNSF Railway closed the CARD clinic in May. Clinic leaders are fighting the court order and have vowed to reopen its doors, but the lawsuit isn\u2019t the only threat to the clinic\u2019s survival.<\/p>\n The federal grant that provides 80% of the clinic\u2019s operating revenue is on a list of cuts<\/a> the Trump administration is considering. If the $3 million grant is cut, the clinic would likely close for good, CARD executive director Tracy McNew said.<\/p>\n The grant was frozen then unfrozen, after the Office of Management and Budget issued then rescinded a memo freezing grants having to do with nongovernmental organizations; diversity, equity and inclusion; and other areas. But White House officials have said they will continue reviewing those grants for potential cuts, leaving McNew uncertain of the grant\u2019s status even as clinic officials \u2014 and Department of Justice attorneys \u2014 fight in court to recover the CARD assets seized in the BNSF lawsuit.<\/p>\n The Office of Management and Budget, the White House. and the Department of Health and Human Services did not respond to NPR and KFF Health News\u2019 request for comment on the status of the clinic\u2019s grant.<\/p>\n Cutting the grant might not be easy, said Tim Bechtold, an attorney who represented the clinic in the BNSF case. The Affordable Care Act gave Libby asbestos patients access to Medicare and calls on the federal government to offer grants to fund diagnostic services for them.<\/p>\n In 2020, the Montana Supreme Court ruled<\/a> that BNSF could be held liable for spreading asbestos along its tracks when the railroad shipped Libby vermiculite across the country.<\/p>\n The year before, the railroad sued<\/a> under the False Claims Act, arguing that CARD defrauded the government by erroneously diagnosing patients and helping them apply for Medicare benefits. The law allows private parties to take on fraud cases<\/a> on behalf of the federal government if federal prosecutors decline to take the case. Money awarded in those cases goes back to the federal government, but private parties keep a portion of the winnings.<\/p>\n A jury sided with BNSF\u2019s claims<\/a> that CARD falsified the records of more than 300 patients who received federal benefits. CARD officials said those patients did not receive a diagnosis of asbestos-related disease, but the clinic determined them eligible for Medicare under the ACA based on abnormal radiology readings.<\/p>\n In a statement to NPR and KFF Health News, BNSF denied the lawsuit was an attempt to avoid legal liability for asbestos contamination along its tracks.<\/p>\n In 2023, the clinic filed for bankruptcy, citing the BNSF lawsuit<\/a>. In May, BNSF persuaded a county court to allow the company to seize<\/a> nearly all of CARD\u2019s property to collect its share of the roughly $6 million court judgment. It took control of nearly everything, from the clinic\u2019s building to its lawn mower.<\/p>\n The federal government is coming to CARD\u2019s defense<\/a>. In a court filing, the office of the U.S. Attorney for Montana, Kurt Alme, said that because CARD property was largely purchased with federal grant funding, BNSF cannot seize it.<\/p>\n The case has moved to federal court and the judge is expected to rule on whether BNSF can seize CARD assets to collect its portion of the judgment. In the meantime, CARD patients will have to look elsewhere for screening and treatment, services that could be difficult to find.<\/p>\n Diagnosing people with asbestos-related disease or showing that other conditions are tied to asbestos exposure requires expertise, said Robert Kratzke<\/a>, an oncologist at the University of Minnesota who studies cancers tied to asbestos.<\/p>\n \u201cMost physicians would be modestly clueless about what to look for,\u201d he said.<\/p>\n Kratzke explained X-rays or CT scans need to be done in a specific way and read by specialized doctors, known as B readers<\/a>, to diagnose patients.<\/p>\n Kratzke said rebuilding the expertise of the CARD clinic would be difficult in a small town like Libby.<\/p>\n \u201cIt would be very, very hard for the physicians and hospitals in Libby to follow these people as they would need to be followed for the rest of their lives,\u201d Kratzke said.<\/p>\n Jenan Swenson is the only one of Gayla Benefield\u2019s five children who hasn\u2019t yet been diagnosed with an asbestos-related disease.<\/p>\n She received the results of her last screening at the CARD clinic the day before it closed in May. For now, the 62-year-old is in the clear.<\/p>\n Swenson expects to eventually develop breathing problems from her asbestos exposure as a child. Her mom, for whom she is a caregiver, also needs ongoing screenings for lung cancer.<\/p>\n She worries they\u2019ll have to travel out of state to find that care if the CARD clinic doesn\u2019t reopen, which Swenson said they can\u2019t afford. She doesn\u2019t think her family will be the only one.<\/p>\n \u201cThere\u2019s going to probably be a lot of people just lost out there with no place to go,\u201d Swenson said.<\/p>\n This article is part of a partnership with <\/em>NPR<\/em><\/a> and <\/em>Montana Public Radio<\/em><\/a>.<\/em><\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\nUSE OUR CONTENT<\/h3>\n