At 62, Paul Cotter looks like the kind of guy who could pull you from a burning building. 

He wishes he still had the chance. 

The burly retired Worcester Fire Department lieutenant’s eyes light up as he talks about the thrill of crawling through a burning three-decker. His face, intense yet genial, shows a satisfaction most will never know when gazing at a photo taken after he pulled a man out of one decades ago. 

“Finding and helping people in their greatest time of need, you know, is pretty rewarding,” the Worcester native said recently. 

It was a weekday afternoon in his Rindge, New Hampshire, home, an impeccably furnished, woodsy yet modern space accented by two wall-mounted bucks he bagged a few years back. 

It’s a place to which many would be happy to retire. But Cotter would rather not be here, sitting at a kitchen table, retired on disability, telling a reporter and photographer about the glory days he’d still like to be living. 

He’d always envisioned working his rescue team job as long as he could. Seven years ago this month, retirement seemed a long way off, given that he’d just been promoted and, at 55, could still deadlift 500 pounds. 

And then out of nowhere, he and his high-school sweetheart and wife, Diane, were gut-punched by test results from the doctor. 

Cotter had prostate cancer. It was aggressive. He needed surgery, and soon. 

“I pretty much didn’t tell anybody,” Cotter said, recalling how he worked right up until the day before his January 2015 operation. 

“I didn’t want to believe I was sick. I didn’t want to be the poor guy with cancer,” he said. “I couldn’t bring myself to talk about it.”

He never worked another day again. 

The long recovery, the hellish side effects and the mental toll that followed are subjects he doesn’t like talking about much, other than with the band of fellow firefighters whose names and cancers he’s recorded on a yellow pad of paper these past seven years. 

The list is now up to 38 names. All but two are from his department. It’s by no means complete.

“These are just the guys I know about,” said Cotter, who has no family history of prostate cancer — the same disease that’s afflicted many of his friends.

The question is why. It’s one Diane, who fell in love with Cotter the moment she laid eyes on him junior year, has been crusading to answer for years. 

According to federal data, firefighters have a 14% higher chance of dying from cancer than the general public. From 2002 to 2019, 66% of line-of-duty deaths resulted from cancer, said the country’s largest fire union, the International Association of Fire Fighters, a figure that increased to 75% in 2019.

While the traditional line of thinking has been that the carcinogens in smoke underscore many cases, information Diane has painstakingly assembled over the past five years has raised a question the fire services are just finally beginning to grapple with. 

What if firefighters are being killed by their own turnout gear? 

Diane Cotter is no stranger to inconvenient truths, having learned her first lesson on how hard life can be at age 6. 

That was the year she witnessed her mother’s first suicide attempt, a slit of the wrists whose image is forever burned in her memory. 

“She barely recognized me,” Diane recalled of her hospitalized mother after doctors had saved her and treated her with electroshock therapy. 

Diane’s family story is steeped in local history. Her mother, after facing a traumatic childhood, was taken in by beloved late area luminary Anthony "Spag" Borgatti. 

Her father was Johnny “Dee” DiBenedetto, a charismatic city icon who managed “The Palace” — the Loew’s Poli Theatre, today's Hanover  — for 30 years until 1972. 

DiBenedetto “wined and dined” star female performers, including Lauren Bacall and Jayne Mansfield, at the El Morocco restaurant after shows, Diane recalled. Though beloved in the city, he had his flaws — including a severe gambling problem, she said — which led to family turmoil and forced her to develop a thick skin. 

Diane also gained strength from watching her mother, Patricia Doherty, overcome her alcoholism and go on to sponsor hundreds of people at Alcoholics Anonymous over four decades. She died in 2012, a year after Dee. 

Her mom’s strength — and her father’s gift of gab — have served Diane well as she has embarked on a journey the past five years that reads like a Hollywood script. 

Indeed, it was, she says, the famed activist Erin Brockovich who first turned her on to an idea that a specific kind of chemical used by manufacturers in turnout gear could be problematic.

Turnout gear is the personal protective equipment worn by firefighters. Diane had suspected something dangerous might be in it, but didn't know what it could be. 

In 2017, Brockovich suggested Diane determine whether a group of chemicals called PFAS — polyfluoroalkyl and perfluoroalkyl substances — might be in the gear. 

Ever since the tip, Cotter has relentlessly pursued the prospect with corporations, scientists, politicians and union officials in an ongoing struggle for answers. 

Her work has led to a peer-reviewed scientific study confirming “staggering” levels of PFAS in turnout gear nationwide, as well as hard-fought — and initially opposed — calls for further action by the nation’s largest fire union. 

Six years after she first shined a flashlight on the deteriorating groin area of her husband’s gear, she’s working to turn the spotlight on PFAS, a hazardous group of chemicals that are becoming a growing cause for concern nationwide. 

PFAS are synthetic substances referred to as “forever chemicals” because they do not break down naturally.

Some studies have linked the chemicals to cancer, and scrutiny about levels of PFAS in drinking water nationwide has intensified recently following a slew of new federal regulatory efforts. 

Diane has been looking at the issue of PFAS in turnout gear since 2017. It's been an uphill struggle, she said, replete with stonewalling from chemical companies, indifference from union leaders and, at times, retaliatory ostracism. 

“I will not be silenced,” she said, opining that leaders in Worcester have been too silent on the issue. 

In her typical style — a biting Tweet — Diane recently commented that Worcester officials’ presence at a recent unveiling of a memorial to fallen firefighters contrasts with what she says is a reticence to spotlight PFAS concerns. 

“@TweetWorcester leaders are silent on the issue that is likely killing our firefighters. Their own gear,” she wrote, alleging the city has declined to participate in a PFAS documentary. 

“It’s not enough to stand with us for the photos (sic) ops when we die,” she wrote. 

Diane also posted a screenshot of an email she says was sent out to firefighters in 2018 in which a department safety chief said manufacturers had assured firefighters that PFOA, a type of PFAS, was not in their gear. 

“You asked the manufacturers and they lied to you,” Diane alleged in a corresponding post on medium.com. 

Diane has been writing posts online for years with her concerns, but says fire service and city leaders have not taken up the mantle. 

The Telegram & Gazette filed a records request Aug. 24 for any emails among city leaders regarding PFAS from 2017 to the present. 

No city officials appeared to substantively discuss the issue of PFAS in turnout gear in emails the city released in late October. 

Asked for comment on Diane’s criticism, the city provided a statement from acting Fire Chief Martin Dyer in which he acknowledged the concerns about PFAS in gear and said the department is working closely with its dealer seeking the safest products possible. 

“At this time the department is not aware of any turnout gear meeting NFPA specifications that can be guaranteed to be PFAS-free,” he noted. “We are well aware of and appreciate the advocacy from many fire service professional organizations, individuals and nonprofits concerned about our firefighters’ safety. 

“We will continue to work with our fire service partners and vendors to ensure that our firefighters have the protection they need to accomplish their mission as safely as possible.”

Paul Cotter feels lucky to be cancer-free and is being monitored yearly for any signs of relapse. 

He can’t get back the time he lost in the department, or change the way cancer changed the trajectory of his life, but he’s grateful for his wife’s push for answers. 

“It’s amazing. It’s unbelievable,” he said of the time, effort and mettle she’s shown. 

The importance of Diane's work, Cotter said, is underscored daily. While she writes blog posts and emails legislators daily arguing for greater scrutiny of PFAS-laden gear, Cotter continues to add names to his list. 

“I went by a guy’s house (on my list) the other day,” he said. “Cancer victim. 

“He and his wife — they had the same look of dread and despair — the great unknown we all had. Thinking, ‘This is it.’ ”

Cotter hopes news stories will make preventing cancer among firefighters a higher societal priority. 

He said many people, including firefighters, appear all too resigned at the higher cancer rates. 

“People just accept that firefighters get cancer and they die,” he said, a trace of anger — and resolve — in his voice. “They don’t blink an eye.”

First invented by 3M in 1948 and still federally unregulated, PFAS chemicals are able to withstand heat, oil, stains, grease and water, and are used in a wide array of products. 

Water- and wrinkle-proof clothing, stain-resistant furniture and nonstick cooking products are just a few products pioneered through the use of PFAS. 

Such modern conveniences were originally marketed as safe and magical. But a growing body of research — and heavy litigation — has unearthed serious concerns about links to a variety of maladies, including cancer. 

The Environmental Protection Agency last month announced an ambitious action plan on PFAS, vowing to finally regulate the chemicals, to force companies to detail what they use and to set enforceable limits in drinking water. 

The move comes after mounting outrage over warnings that the chemical is building up in the blood of virtually every person on the planet. 

The large corporations that created and used the product, namely 3M and DuPont, continued to use it over decades despite growing internal concerns about health risks, litigation has shown. 

The problem first came to a head in the mid-1990s, when Earl Tennant, a West Virginia farmer whose creek was downstream from a DuPont landfill, noticed his cows getting sick. 

DuPont, which had bought part of the land from Tennant’s family to create the landfill, had promised it would not be filled with hazardous waste. 

But it dumped loads of an unregulated PFAS chemical called PFOA into the creek, and more than 100 of Tennant’s cows died. He complained to the company and state regulators for years, but the chemicals and their entry into his water went undisclosed until a Cincinnati lawyer, Robert A. Bilott, filed a lawsuit on his behalf. 

It took Bilott, a corporate defense lawyer who had spent his career to that point defending chemical companies, years to pry documents from DuPont disclosing the existence of the chemicals and their toxic qualities. 

After years of motions and review of hundreds of thousands of documents, Bilott alleged DuPont was long aware of health concerns linked to the chemicals, and that PFOA had leached into water supplies of surrounding communities. 

He uncovered numerous documents he argued showed the company’s disregard for the safety of the public and its own workers in the name of profit. 

Bilott eventually won a confidential settlement for Tennant and, separately, a public settlement for about 70,000 people who drank contaminated water. 

DuPont has ultimately agreed to more than $1 billion in settlements with those who drank the water, including up to $235 million earmarked for medical monitoring and treatment of diseases linked to the chemicals. 

A landmark 2012 study of more than 60,000 class members found substantial links between PFAS and six diseases, including two cancers. 

Bilott’s story was made into a movie in 2019, "Dark Waters," in which he was portrayed by actor Mark Ruffalo. 

The movie, along with Bilott’s corresponding book, "Exposure," show how Tennant, a self-described “old dumb farmer,” succeeded in getting to the truth through his unceasing insistence on pushing the issue.

Two years before "Dark Waters" hit theaters, Diane Cotter had zeroed in on the PFAS concern following correspondence she initiated with Brockovich. 

A self-described simple housewife with a high-school education — she and Paul both graduated from Worcester's Burncoat High — Diane first became suspicious in 2015, when she spotted deterioration of the fabric in the groin area of her husband’s gear. 

She emailed many experts asking for help and, after Brockovich replied and brought up PFAS, immersed herself in research. 

She became obsessed with determining whether PFAS was in turnout gear and, if so, whether it could be threatening the lives of firefighters. 

She said manufacturers refused to provide her information on the makeup of their products, increasing her suspicions. 

From her AOL account on her home computer, she sent out hundreds of emails to advocates and scientists, peppering those who failed to respond with further communiques, imploring them for help. 

Graham Peaslee, an experimental nuclear physicist at the University of Notre Dame, answered Diane's plea. He’d already been researching levels of PFAS in household objects using a novel method that made use of an advanced university asset — the St. Andre particle accelerator — and agreed to test sets of gear Cotter provided. 

The results showed the highest levels of PFAS Peaslee had ever seen in textiles, which sparked interest in a broader study. 

Diane went back to work. She drummed up funding from Boston’s Last Call Foundation, and gear from firefighting allies across the country. 

The result was a peer-reviewed study from Peaslee, released in 2020, that confirmed initial concerns and suggested additional study. 

Peaslee found that PFAS is shed from the textiles over time — and can migrate into other parts of gear — raising concerns that it could possibly be absorbed through the skin. 

Researchers discovered that just handling the gear caused PFAS to rub off on gloves, while dust from firehouses where gear was stored indicated the chemical could possibly be inhaled after degrading in air. 

PFAS was built into the gear for a variety of reasons, including to help it withstand heat and moisture and prevent other hazardous substances from reaching firefighters’ skin. 

But the levels of PFAS in the gear are extremely high, Peaslee said — concerning since firefighters wear and sweat in it often. 

Gear manufacturers have argued that the chemical particles are too large to be absorbed through the skin, an argument Peaslee dismisses. 

“It will go through — the question is how much,” he told the Telegram & Gazette, and how to measure it. 

Peaslee said several ongoing studies are trying to answer that question. He said the concern is that chronic exposure to PFAS over years could put firefighters at an elevated risk. 

“Are we at the step of proving tomorrow that all firefighters will get cancer from this? No,” he said. “But we are certainly showing an exposure pathway that exists.” 

While many gear manufacturers say they no longer use the legacy PFAS chemicals, instead using substitutes that don’t stay in the body as long, Peaslee said the replacements have not been fully studied and may still be problematic for people continually exposed. 

While prostate cancer was not definitively linked to PFAS in the 2012 West Virginia study, the EPA on its website lists the cancer as among three that studies have suggested may be related to PFAS exposure. 

Peaslee said he anticipates more studies in the future will yield additional health concerns. He said it’s particularly concerning to him that some of the top cancers firefighters get, such as leukemia and prostate cancer, are ones that seize on weakened immune systems. 

“Maybe it’s not directly related to the PFAS (itself),” he said. “Maybe it’s because your immune system was compromised by PFAS.” 

Peaslee does not profess to have the answers, and cautions that it’s generally impossible for any one person to definitely know what caused their cancer. 

But PFAS in gear, in his estimation, is on a “short list” of suspects that could increase firefighters' chances of contracting the disease, along with carcinogens in smoke and PFAS that was used for years in firefighting foam. 

Peaslee noted that since he’s been researching PFAS, he’s heard from eight firefighters nationwide diagnosed with a rare brain cancer thought to only impact one in a million people. 

“Why do I know eight firefighters who have that?” he asked. 

Peaslee is among many people, including some environmentalists, who fear the release of PFAS into the environment could be the worst chemical contamination in U.S. history. 

“Rob Bilott uncovered the most heinous corporate environmental conspiracy in history,” Ken Cook, a prominent environment activist who has worked with Cotter, wrote in a review of Bilott’s book. 

PFAS’ revolutionary qualities are a double-edged sword in that, because they never break down, they will forever be on the planet, and have migrated across the globe through groundwater and rain. 

The chemicals build up in the blood of people and animals, with Peaslee noting it’s been found in high concentrations in the blood of polar bears at the North Pole. 

“This is showing up in the blood of virtually everybody on the planet,” Bilott said in an interview with the Telegram & Gazette. 

Massachusetts health officials recently advised people to limit eating fish from five Cape Cod ponds because of concerns about elevated PFAS levels linked to a nearby Joint Base Cape Cod in Bourne. 

Peaslee noted that firefighters for years used PFAS-laden foam in and around training areas and airports nationwide, which may have resulted in PFAS leaching into water supplies. 

Some states are requiring drinking water be tested, including Massachusetts, which has found levels exceeding what state regulators deem acceptable in the water supply of 56 towns, the Massachusetts Sierra Club recently reported. 

Local towns on that list are Millbury, Dudley, Grafton, Princeton and Shirley; Worcester was not listed. 

According to the Sierra Club, the water tested is not treated drinking water — rather the raw supply — and so the results do not mean that the population has been exposed to any contaminated water. 

Bilott is suing numerous chemical companies in a lawsuit he hopes to expand to a class of all impacted Americans over the chemical. 

“We want to make sure the companies that did this — knowing this stuff was going to get out into the environment … are held responsible for paying for the damage that’s being done,” he said. 

The lead plaintiff in the case is an Ohio firefighter who used firefighting foam extensively over his career. 

“(Firefighters) have a right to know whether the same equipment they relied upon to help save lives — the firefighting foam, fire-protection gear and other PFAS equipment — has put their own lives at risk,” Bilott wrote in a 2017 letter to federal regulators. 

Cotter says he did not use firefighting foam regularly, which heightens his concern that his turnout gear could have contributed to his disease. 

Bilott, who has been internationally recognized for his work in the past two decades, said the recent publicity "Dark Waters" generated, along with the longtime dedication of people pressing the issue, is beginning to bear fruit. 

“It’s taken incredible efforts of individuals to push this,” he said, including Tennant, residents in West Virginia and, more recently, Diane and Paul Cotter. 

He said he believes such efforts are “finally elevating the issue” to the attention of people who can properly investigate. 

U.S. Rep. James P. McGovern, D-Worcester, said in an interview that federal and state prosecutors ought to be criminally investigating the companies that released PFAS into the environment. 

Bilott’s book details a wealth of information DuPont and 3M failed to disclose to regulators about PFAS.

The EPA in 2020 acknowledged it has opened “multiple criminal investigations” surrounding “PFAS-related pollution.”

“There needs to be legal action moving forward. Attorney generals and federal investigators need to look at what’s happened here,” McGovern said. 

Attorney General Maura T. Healey’s office declined to say whether she is considering a criminal probe. 

Healey released a statement in which she expressed grave concern over the topic, and said she has pushed for funding for municipal cleanups and state and federal legislation to address PFAS-related harms. 

McGovern, chairman of the House Rules Committee, noted that DuPont for years was aware of potentially toxic effects of PFAS, including from studies it conducted of its own workers.

According to Bilott’s book, studies in the 1960s at 3M and DuPont identified health concerns in animal testing. DuPont scientists in 1970 wrote that the PFAS it used, called PFOA, was “highly toxic” when inhaled; a decade later, Bilott said, they deemed it “slightly to moderately toxic” with skin exposure. 

“Continued exposure is not tolerable,” DuPont executives concluded in a 1980 meeting, according to minutes Bilott uncovered in his lawsuit. 

DuPont and 3M pulled female workers out of PFAS-facing work in 1981 after studies indicated the chemicals damaged fetal eye development in rats. 

Two of seven women at DuPont who worked around PFAS gave birth around that time to babies with eye defects. The companies ended up returning female workers to the line after a second study deemed the first to be erroneous.

In 1984, DuPont detected PFAS in the water supply of a community near its West Virginia plant, but did not disclose that information to the local water authority.

By the early 1990s, both 3M and DuPont had discovered elevated cancer rates among some workers. Despite that knowledge, DuPont did not tell Tennant about the chemical dumped into his creek. 

Concern about the chemical roiled internally at the companies, Bilott found, with lawyers and scientists at DuPont suggesting disclosures that business leaders ultimately decided against. 

McGovern spoke with Bilott and Cotter in 2018, after she was the first person to reach out to him with concerns about PFAS.

“She told me nobody was listening to her — people just didn’t want to believe what she was saying,” he recalled. 

Since that meeting, McGovern has written letters to the CDC urging firefighter PFAS studies, helped to found a Congressional PFAS Task Force and introduced multiple bills on PFAS, including one aimed at protecting firefighters. 

This July, as chairman of the Rules Committee, he brought legislation to the House floor that would, among other measures, designate two PFAS chemicals as hazardous substances. 

The law passed the House but has yet to be taken up by the Senate, where it would likely need 60 votes to get around an anticipated filibuster. 

McGovern and a Michigan Congressman — with substantial help from Cotter — also got 70 members of Congress to support the placement of $100 million in the $1.85 trillion budget reconciliation bill being debated by Democrats. 

The money would go toward helping fire departments buy new gear being made that contains less PFAS. 

McGovern called Diane a “trailblazer” on the PFAS issue. 

“She is persistent, and she is fearless,” he said, echoing comments made by Peaslee. 

“She’s a force of nature. Nobody’s going to get in her way,” Peaslee said. “If they did, they’d regret it.”

Peaslee noted that the International Association of Firefighters was initially resistant to Diane’s concerns but has done a “180” in a short period of time. 

Diane said the process was long and arduous. When she initially brought her concerns to the union, it reiterated manufacturer talking points, she said, leading her to believe the companies and union leadership were too cozy. 

Gear companies sponsored union productions and even an annual cancer summit, she said. She began to blast the unions over alleged conflicts of interest on social media, which she said led to a “shunning” by many officials. 

It was a tough time for the couple, who count among their most sacred possessions a Harley-Davidson that belonged to Timothy P. Jackson, one of the six city firefighters who perished in the December 1999 Worcester Cold Storage and Warehouse Co. fire. 

Diane is the first to admit that she was “savage” in many of her posts — especially after “the shunning,” as she calls it, began. 

She believes, based on conversations with “allies" in the fire service, that the directive came from the top of IAFF.

She remains suspicious about connections between gear and chemical makers and past IAFF President Harold Schaitberger, who, according to The Wall Street Journal, was under investigation last year by the FBI for potential financial improprieties.

But her relationship with IAFF has improved after the new president, Ed Kelly, began working with her and has taken a hard line over PFAS concerns. 

Diane praised Kelly for his work on the issue. In the past year, the IAFF has voted to stop accepting sponsorship from companies that use PFAS and to actively oppose PFAS in gear. 

While some companies have created outer shells of turnout gear that are PFAS-free, no garments are completely clear of the chemicals.. 

That, Diane says, is because the National Fire Protection Association, a Quincy-based nonprofit that sets industry standards for firefighting gear, has kept in place a test she says only PFAS products can satisfy. 

Diane alleges the test serves corporate interests of a DuPont spinoff company because its PFAS-laden product, Teflon, is the only one that can satisfy it. 

The test requires an inner moisture barrier in gear to pass a UV light test, which Peaslee told the Telegram & Gazette he does not believe is scientifically necessary since that part of the gear isn’t exposed to much sunlight. 

The IAFF, citing Peaslee’s statement, recently petitioned NFPA to remove the test in an emergency measure, but members of a technical committee declined. 

Asked for comment, an NFPA spokesman pointed a reporter to a voting tally from the NFPA committee that showed votes against the change were not limited to manufacturers. 

At least five firefighters or labor leaders on the committee voted down the change, with many saying further study was needed to ensure it was needed and that there would not be unintended consequences. 

A task force on the topic has been created, NFPA said, and the issue will continue to be considered as part of an ongoing policy review process. 

According to NFPA documents, the test was created in the mid-2000s as a response to concerns about the inner moisture barrier degrading too soon in some turnout gear. 

Diane has emailed many U.S. representatives, including McGovern, as well as U.S. senators requesting a Congressional inquiry into PFAS in firefighting gear. 

She believes a 9/11-scope commission that would look not only at chemical companies but also any potential wrongdoing by fire institutions is warranted. 

Diane told the Telegram & Gazette last month McGovern and other politicians have been helpful when it comes to filing legislation, but have not addressed her call for a Congressional probe. 

In a statement to the Telegram & Gazette last week, U.S. Sen. Elizabeth Warren joined McGovern in supporting calls for federal probes. 

While Bilott says he’s “cautiously optimistic” the new EPA action and proposed legislation will make an impact, he’s also heard promises of change before. 

As he details in his book, he first requested EPA take decisive action in a lengthy filing with the agency in 2001, but has watched in frustration as similar government promises that followed rang hollow.

Documents he uncovered in litigation indicate the EPA at one point publicly echoed DuPont talking points at the behest of the company, signaling a relationship he argues was “far too cozy.” 

One of the consultants DuPont hired to help sort through its PR mess was a former EPA deputy administrator. A “revolving door” between government and corporations was much more evident in West Virginia, he wrote, where “several” state regulators at the Department of Environmental Protection who frustrated his efforts had once been lawyers for a firm that represented DuPont. 

At one point in the class-action litigation, the West Virginia DEP determined that drinking water with up to 150 parts per billion in PFAS was safe — a level 150 times what DuPont’s own internal standard had been. 

Multiple members of the team that created the higher figure, including the top DEP leader on the team along with a toxicologist for DuPont, admitted to destroying documents related to the process, Bilott wrote. 

The EPA, in its current, unenforceable advisory limit, advises that PFAS levels in drinking water should not eclipse 70 parts per trillion. 

That amount is 2,142 times smaller than the 150 parts-per-billion figure identified by the West Virginia EPA in 2002. 

The Massachusetts DEP’s limit for PFAS is 20 parts per trillion. 

Contact Brad Petrishen at brad.petrishen@telegram.com. Follow him on Twitter @BPetrishenTG