On Kevin Leago’s July CT scan, his torso looks like it has been riddled with birdshot. Dark splotches speckle his liver, his pancreas, his spine, marking where his neuroendocrine cancer has spread.

The pain in his bones has left the 38-year-old Houston Fire Department senior captain unable to work since the end of May. Within 30 days, he will exhaust all his sick and vacation time, leaving him with no income.

His doctors say his best shot at survival is a new treatment that is not offered at the hospital covered by Leago’s city health insurance.

Workers compensation benefits would provide Leago a paycheck while he is ill and allow him to transfer to any hospital that accepts him, but the city of Houston denied his claim. The city’s third-party administrator argued Leago’s cancer is unrelated to his 17 years of service in the fire department, despite a Texas law requiring the government to presume that firefighters’ cancers are caused by exposure to carcinogens on the job.

“Part of me thinks if the workers comp people would do what they are supposed to do, I wouldn’t have to worry about my bills getting paid, or a lot of this treatment and insurance,” Leago said during a chemotherapy session last week. “You can’t already be drained and trying to fight cancer at the same time.”

LAGGING BEHIND: Texas launches probe of HFD safety procedures

Leago’s predicament is hardly unique. In the past six years, more than nine in 10 Texas firefighters with cancer have had their workers comp claims denied, according to state statistics.

Union leaders and state legislators say cities have ignored Texas’ presumptive cancer statute for first responders, and face few consequences for denying claims. The result, they say, is that firefighters often see their personal savings evaporate even as they compromise on their care.

“The sky-high denial rate of cancer is the first problem,” said Marty Lancton, president of the Houston Professional Fire Fighters Association. “Firefighters with denied claims often have fewer treatment options and face the risk of financial ruin because of lost income.”

All seven HFD members with cancer who have filed workers comp claims since 2016 have been denied, according to the union. That abysmal batting average has encouraged others to wait on the Legislature to strengthen the law protecting sick firefighters before filing their own claims.

Leago does not have that kind of time.

Law protects firefighters

The Texas Legislature in 2005 unanimously passed a change to state law that requires the government to presume, if firefighters are diagnosed with cancer and meet certain criteria, their illness was caused by exposure to carcinogens on the job.

The statute shifts the burden from firefighters having to prove their cancer was caused by firefighting to their employers, who must prove it was not. Legislators wrote the law to help doctors, lawyers, insurance providers and union representatives avoid wrangling over individual cases so firefighters can receive benefits quickly.

The state firefighters union and lawmakers say cities have subverted the law by denying workers comp claims from firefighters who qualify.

Of 117 workers comp cancer claims filed by firefighters in the state since 2012, 91 percent have been denied, according to the Texas Department of Insurance.

“It is astoundingly high,” said John Riddle, president of the Texas State Association of Firefighters. “It’s higher than any other work-related injury that workers comp has denied.”

Firefighters are substantially more likely to win benefits on appeal, prevailing in 64 percent of cases over that same period. Yet, less than one-fifth of firefighters disputed their denied claims, daunted by the prospect of spending months or years sparring with insurers in court while simultaneously battling cancer.

Houston attorney Mike Sprain, who has represented dozens of firefighters in their appeals, said the workers comp process has become so arduous that firefighters with cancer are unlikely to get a claim approved without an attorney.

The lawyer said a 2011 Texas Supreme Court ruling further puts firefighters at a disadvantage. That decision exempted workers comp administrators from bad faith claims. Previously, cities could have been held liable for dismissing a worker’s claim without evidence.

State Rep. Dustin Burrows said that since cities now can deny workers comp claims with impunity, they have an incentive to spend as little money as possible.

“I am very, very, disappointed in what I’m seeing,” Burrows said. “I think there is a really strong argument that’s what’s going on here … that maybe they’re making economic decisions rather than actually contractually living up to their obligations.”

The Lubbock Republican filed a bill this past session that would again allow workers to challenge bad faith claim denials. It passed the House, but died in the Senate. Burrows said he plans to try again when the Legislature reconvenes next January.

Law interpretation questioned

The city of Houston’s benefits provider did not respond to a request for comment, but a memo written by the Texas Intergovernmental Risk Pool, which handles workers comp for more than 2,700 other Texas municipalities, outlines the strategy firefighters say cities use to dodge the cancer presumptive law.

The memo states Texas law presumes only three types of cancer are caused by firefighting: testicular, prostate and non-Hodgkin’s lymphoma. The risk pool cites a 2007 paper that states dozens of studies have linked firefighting to those three illnesses.

Dr. Robert Deuell, a physician and former state senator from Greenville who wrote the presumptive cancer statute, said that interpretation of the law is incorrect.

“It was intended for any cancer caused by firefighting exposure and not limited to any particular number of cancers,” Deuell said.

Firefighter unions say cities are ignoring a wealth of research that links their occupation to other forms of cancer. The presumption statute states it applies to “cancers that may be caused by exposure to heat, smoke, radiation, or a known or suspected carcinogen” as determined by the International Agency for Research on Cancer.

The IARC’s published research on cancer in the fire service is 559 pages long. It cites scores of academic papers, including a meta-analysis of 32 studies that concluded 12 cancers were possibly or probably caused by firefighting.

Deuell said he is not surprised the Texas Intergovernmental Risk Pool has taken a narrow view of the presumptive law because its administrator, the Texas Municipal League, lobbied against its passage.

David Reagan, counsel for TIRP, said the risk pool must balance the needs of firefighters seeking benefits with those of cities trying to spend prudently.

“It’s not that we’re not sympathetic to firefighters. We are,” Reagan said. “But at the same time, we have to follow the law in spending taxpayer money.”

Even if firefighters eventually win their workers comp cases on appeal, they risk provoking lawsuits from the cities that employ them. The city of Baytown sued firefighter Patrick Mahoney, who has thyroid cancer, after he won workers compensation benefits on appeal. Mahoney sought workers comp because the city’s insurance plan does not cover cancer treatment.

The city of Houston sued 23-year HFD veteran Margaret Roberts in 2015 after she appealed and won a workers compensation claim for her blood and bone cancer. Roberts died in 2017, but the city’s suit against her estate continues.

Daniel Roberts said he and the couple’s three children have struggled to find closure in the 19 months since his wife’s death because the city’s lawyers refuse to concede her cancer was caused by firefighting.

“How did she get this sickness? On your damn job. You know what I’m saying?” Roberts said. “It should be against the law, the way they do families the way they do. They should be prosecuted.”

Out of options

Kevin Leago feels fortunate doctors caught his cancer in the first place. Unlike the Austin, Dallas, San Antonio and El Paso fire departments, HFD does not send its firefighters for regular physicals, where illnesses can be detected.

Leago discovered he was sick after the ambulance he was driving collided with another vehicle in October 2012. Doctors ordered a CT scan to survey his broken back and wrist, and discovered a tumor in his pancreas. He was 32, and his wife, Breck, was 7 months pregnant.

“The only thing that was going through my mind was, God, please let me see my daughter be born,” Leago said. “Because that cancer is usually a very quick killer.”

A surgery in 2013 removed his spleen, 22 lymph nodes and 70 percent of his pancreas, and the cancer vanished for nearly five years. It returned in the fall of 2017, and he went under the knife again. When Leago fell ill after extinguishing a routine fire in May, a CT scan revealed the cancer had spread throughout his body.

The fentanyl patches he wears soothe the aching in his bones, but are so strong he cannot work or drive. Breck takes him everywhere, including chemotherapy sessions in Houston, more than an hour from their home in Winnie. Their lives have become an interminable cycle of doctor’s appointments, phone calls with insurers and pit stops on I-10.

Leago does not smoke and is physically fit, and believes the most likely explanation for his cancer is exposure to carcinogens — including benzene, formaldehyde, and asbestos — his body regularly absorbed on fire calls. He cannot pinpoint a blaze that was particularly hazardous, and researchers have been unable to conclusively link pancreatic cancer to firefighting.

Leago said his doctors, who declined to speak with the Chronicle, are reluctant to state his illness likely was caused by firefighting because they are worried about having to defend that position in court. Legislators say the presumptive cancer statute is supposed to relieve doctors of that burden, precisely because the provenance of an individual case of cancer is difficult to trace.

Now that his cancer has progressed to stage 4, Leago said his doctors believe his best chance for survival is a new treatment called PRRT, a molecular therapy used to combat neuroendocrine tumors.

The Kelsey-Seybold Clinic, where Leago receives chemotherapy, does not offer PRRT. MD Anderson Cancer Center, the famed cancer hospital 2,000 yards east on Holcombe Boulevard that was ranked last year as the best in the world, does perform the treatment.

Leago’s city health insurance so far has refused to cover care from MD Anderson because the hospital is out of its network. If his workers comp claim is approved, he can choose any hospital that would accept him.

For now, Leago focuses on spending time with his family on their 13-acre ranch in the country, where cows, chickens and an affable pig roam the property. The couple has not told their five-year-old daughter, Kenzi, much about his illness. She sees how her daddy’s walk as slowed, though, how he is too sore to carry her to bed or unable to do many of the activities they once shared.

Leago finds purpose in his fight for benefits. Though his treatments leave him fatigued and nauseous, he still finds time to consult with his attorney and the firefighters union about his worker’s comp appeal strategy.

By having his denial overturned in court, Leago hopes to create a path for other firefighters to follow with their own claims.

“I want people to be able to take my experience, and use that, and do them some good in the future,” he said.

St. John Barned-Smith contributed reporting.

Zach Despart covers Harris County for the Chronicle. You can follow him on Twitter or email him at zach.despart@chron.com.