Document 2R8DMRx6xkj7ekEZZ07drxr8r

FILE NAM E: Saranac 7th Sym posium (SSY) DATE: 1952 DOC#: SSY032 D O CU M EN T DESCRIPTIO N : Transcript of Presentation by Dr. M cGee, Followed by Discussion 112a tarted a little late and ao I think we'll proceed right now with the other papers, and try to combine our discus sions having Just a breathing space in between the two groupn in the program* The next part of our consideration of viewpoints is The Functions and Value of Medical Boards and Medical Examiners in Controverted Compensation Cases, and to open the discussion, we have the Medical Director of the Hercules Powder Company, one of the country's leading industrial p hys icians. I present to you Doctor Lemuel C. McGee. BY DOCTOR McGEEs M i 9 Donlon, Mr. Waters, Ladies and Gentlemens Having Just learned that the chief extravagance in our ex penditure of funds for man, needs to be compensation, lay and medical diagnosis and treatment being mentioned fore most, I should remark at this point that I fesl very like the tree surgeon who had fallen out of his patient* The foreword on the program for this symposium gives, as the objective for the meeting, that industrial health be improved. What relation to that objective has the function of a medical board and medical examiners In ' controverted compensation c&sesT It is agreed by many of us that the most useful result of laws granting compensation, for industiral injur ies is that of establishing working conditions in industries,, 1i J t?; I- ' >- ,y ? Tina not pise 612 BI DOCTOF. MoQEEi Kill Donloo, Nr. Vatere, Ladies and Gentleaeni Havlre Just learned that tba chief extravagance in oar expenditure af fund*, for sen, n**d* to ho compensation, lay and aedleal diagnosis and treatment being nantioaad foremost, I *** remark at -><* point that I feel wrj aoch like the tree surgeon mho had fallen out ef hi* patient* The foreword on the program for this eympoaitmi give*, a* the objective for the meeting, that indoetrial health be improved* Vhat relation to that objective haa the function of a mertlnsl board and nedleal examiner* in controverted compensation oaaeet It la agreed Iqr many of ua that the aort ueefal result of lam granting eonpenaetion for industrial Injuries la that of establishing working oondltlona in industries* The statutes corering compensation for occupational disease give support to the industrial hygiene movement similar to that which the statutes for injury gave to the safety move ment. There is no reason not to believe that sueh a salub rious sequel may be had from the wise administration of the laws dealing with occupational disease* To this end, it asjet be remembered that the laws refer to occupational diseases and not to the legion of Imo^n non-occupatlonal ills to which the human flesh is error* By providing compensation for occupational diseases, accurate diagnosis and the recognition of correct etiology have been given new elgnifloanoe* If industry is penalised by payments for non-oocu- patlonal afflictions, there would appear to be less incen tive for in-plunt health and industrial hygiene programs to avoid occupational disease as a responsibility of industry* 1 know of no state law that says the employer shall pay for all illness contracted in the course of employ ment Including those of non-occupatlonal origin. In theae comments, I start with these premisest One, that compensa tion laws for both injury and disease, arising out of and t because of occupation, are desirable in principal; number An.d. two, that good administration even of inadequate laws, can reach equitable and worthy ends; number three, that it la accepted aa desirable to reduce errors In decisions to a I 14* Bd.nle u a * Competent medical diagnostic service from a team of medical examiners can aid In minimising errors In occu pational condensation decisions. The past few years has seen a trend towards liberalisation of benefits and full coverage of occupational diseases Instead of schedule coverage* Forty-three states. In addition to Alaska, Hawaii, Puerto Rico, the District of Columbia, and federal Jurisdictions under the Longshoremen's Act, have some form of coiqpens&tlod for occupational disease* In twenty or more states, there Is provision for medical examiners to furnish some type of service to the adl miniatrative set-up. Various reasons have been presented for a board of medical examiners. Some of these era the following} Let ua list them very quickly, because It would seem unnecessary to elaborate on any point. They are rathejf obvious to most of you* Humber one, controvert in compensation hearings usually arises from an effort to answer one or more ol thesd questions. Ia there a disability? What la lta degree? ! What is its cause? These are radical questions of fact, and I not of law. Their answer requires medical study and diag- ! nosls. ! Humber two, In industrial medicine as In all as pects of medicine, the individual is paramoutn. To sa*egu .-d -fils, the Interests of the industrial worker, the physician suit have the opportunity to investigate, examine and advise ae an expert. It la important that there be a place for a quiet and objective discussion to dispel discrepancies or at least to weaken them* Such consideration should be car ried off in good faith with no end other than to serve the truth* Number three, an understanding of medical term* inology may best be given by a medical board. Disagreement^, confusion and errors, are ofttimes the result of simple problems of symantios* The language of the crafts must be made intelligible to those untutored In the craft* Humber four, there has been agitation for sene plan which wlllavold the undesirable spectaole of incompe tence and prejudiced testimony of medical witnesses selects^ for opposing litigants* Number five, a medical board can do much in select ing thoee patients who need rehabilitation measures* Max imum lisilts on medical benefits are said to exist in the statutes of seventeen states currently* The worker needs to be made ready for the Job before these benefits expire* Rehabilitation properly has becose an important part of the I compensation program. It is -wholly likeable to use the cur-f ative and re-training periods following injury or disease j to restore and, if possible, improve the earning power of i I 616. the handicapped worker. Here is a place for guidance fro* capable medical examiners. Number six, the fairness of the method of assess ing the cost of workmen's illness against business as such, on the ground of aggravation of a pre-existing condition, in coming more and more into the question. Numerous degenera tive diseases afflict the human body and go undetected for years. Progress towards serious disablement may beunhdetotal ed by the victim, his co-workers, his family and even by hli family physician. Medical examiners are our best recourse in dealing with the question of aggravation or acceleration of pre-exiating disease and Judimially allowing the benefit of the doubt to the claimant worker. Number seven, from time to tine, one observes the injudicious procedure of assuming that disease recognised following an accident was, therefore, due to the accident. A vary poor reasoning for today, indeed. A Judge has been quoted as saying, whether an event was an industrial accident is to be determined not by investigation but by the average comnon sense viewpoint of the man. I must say flatly uhat the common sense viewpoint has led to grievous errors in medical diagnosis and that the average &an haa been of as toundingly little help in medical progress. j Recently, a woman bruiaed her breast, which event ! directed her attention to a tumor underlying the injury. ! Coasnon sense led her to euppose that the bruise caused the tumor* The tumor was a cancer antidating the bruise by a few weeks* She probably has been saved from surgery, whioh was her good fortune, in getting the bruise at that time* The connon sense viewpoint of the average nan long insisted that the earth was flat* It was the uncommon . wisdom of the few exceptional men that demonstrated the earth was not flat. I do not wish to labor the point* ; Medloal boards will make mistakes, but there will ; be much fewer such mistakes than if medical decisions are j mads by those untrained in that field. If given the oppor- j tunlty as technicians, competent medical examiners can resell eloser to the truth based on the knowledge available to our j generation than can lay administrators working alone* j Humber eight, a medical board is a unique and ! highly useful center for the accumulation of new knowledge of disease processes and of their relation to occupation* Careful study of the accumulated experience of medical ad- viaory boards with reports to medical Journals will further clarify obscure disease and, in turn, secure more equitable settlement of compensation benefits* A formidable advance to knowledge is seen in the report by Watkins, based on the medical reports of the Ad visory Board to the Industrial Commission to the State of Arizona* It is generally agreed that medical testimony is , 18* indispensable when the existence of a medical disability, its degree and cause are inherent. The inherent cause in disease claims increase the need for medical guidance in industrial administration. Such guidance is particularly important in states whsre oc cupational diseases are covered under broad provisions and questionable claims are more likely to be brought under such coverage or provisions and contests based on causal relation ships are more likely to arise* The mechanism whereby the physician's x1mal contribution can be made to the administration of the compensation system, I believe to be a legal matter* In the symposium held here in 1947, I questioned the wisdom of any plant which tranaferred legal reaponsibilitiea of m compensation commission to a physician or a medical board* It is repugnant to the Anglo-American tradition* of Justice to place a litigant at the mercy of witnesses he can not see or challenge, to have his rights stand or fall on the basis of unrevealed facts which might be refuted or explained. Possibly a representative of the medical board j should be available for questioning and cross-examining at the hearing. It may be desirable that the medical board review testimony from the hearing to see If there are ad ditions to the information which was available to them when' making their decisions on medical facts. | 419* Waters has said, from my own experisnce, I be lieve that medical boards and consultants appointed on the provisions of occupational disease statutes, have material ly assisted in the administration of the law* What agency is better qualified to pass on con troversial medical questions than a trained impartial med ical board, thoroughly experienced in the subject matter of the disease for which compensation is eoughtt At a Harvard Law School dinner in 1895, the late \ Mr. Juatioe Holmes remarked! An ideal system of law would draw its postulation and its legislative Justification from science* The aim of social laws is Justice and not abuse* In these remarks, I would like you to understand that they represent the point of view of a physician* I 1 have had no experience as a medical examiner and no exper ience as an administrator of compensation laws. Possibly an example would illustrate my point of view better than i anything else* In the late war, World War II, a young man nine teen years old, named Joe Doakes, worked for my company in an ordinance plant. The plant was owned by the Ordnance ^Department of the United States Army, and we were the oper ators under contract for that plant* 1 Joe Doakes was involved in an explosion with flre^ i lost this ear, and had a badly scarred area representing tha 620* opposite side* Under the lave of that state, Joe was entit" led to medieal treatment, maximum recovery of his hearing, but no plastic surgery. The carrier for the Insurance of the plant looked at the problem and threw up his hands, tohen It was called to his attention. But then it was further called to his attention by the Medical Department that we hadn't done our job properly, morally. Eere was a man who was going to get less than a thousand dollars under existing; lavs* Ee had a sear on one side and nothing to mark the external epidermis, the >ther side there was a small sear gnarl of tissue. That man had his lifetime before him within which, to compete with people who had a more pleasing appearance in trying to get a job* The compensation oonraisslonsr saidj we're sorry, this is all that we can do in this state; there is no provision for plastic surgery, ae you want* The in surance carrier said, we agree thoroughly; though you're quite right, but unfortunatdy, under our contraet with the government, there is nothing we can do. We have got to give the benefite allowed by the state law, that's all we can do; otherwise, w e 're going beyond our authority and power* We talked with the commanding officer at the Ord-- j nance Depot, and he eaid, I agree with you thoroughly, Doe-- j j tor, you haven't discharged your obligation to this man by j turning him loose like this, but there is nothing I can do;t muat fit the contract for whatever funds you have in thie direction. We had recourse to our omnibus clause. Our good friends, the attorneys, in setting up the contraot which we had, wisely provided that any employee of my orgard ration at the Ordnance plant, was to receive any consideration and benefits which the employees of the same organization in a company owned plant, would receive. That omnibus clause enabled me to put out some help to this man. Then there is the example of Mr, A, who had his eye treated repeatedly by a plastic surgeon and it took aboi.t five years to get the ultimate best coeraetie and visual r erulta. Long after the compensation commission was through with that, we had the bills and we took care of Mr. A's eyes, so we pulled that exit. We found another man with plaatlc eurgory to take care of his appearance, another one with a very serious orthopedic defect going over years and going far beyond eomi of the situations in the various states. At the time -a laid that before the commanding officer and he said. Doctor, you're bound to ask it. Now I 'm in a position to back up the necessary treatments, to take care of the expenses of sending this nan to a plastic surgeon in a nearby town, carrying this thing over a year and a half. It ran much no re i than allowed under the law. The photographs of the yo^og j TACT TBM PAC3 422. an later on shoved a aloe ooaaetle revolt. That la the point ef Tiev that I aa presenting la oooeeetioa with the probleas of the aedieal board la vorkaen'e eoepensatlon. you. men later on showed a nice cosmetic result. That is the J point of view that I am presenting in connection with the Iproblem* of the medical board in workmen's compensation. Thank you* (Applause)* BY MISS DONLQNt Thank you, Doctor McGee, for that introduction to the discussion of functions and values of medical boards and medical exawdners in controverted compensation cases and for that very interesting little example of what your company i did outside its requirements to do so* I 'm sure that those who, like Doctor Hcgee, approach these problems with a more Vmn*n concern for people, would always try to do the extra little thing as nioely as he was able to do it in that caae, I think, of course, in a controverted compensation case such as we're discussing, our problem is, what are tha isruas under the compa nsation laws, and I'm sure Doctor McGee was only telling us that laws can not he written to cover every situation, and that you do have to bring a human viewpoint to lt Not, as to the medical boards and medical *xamin- ers, Sew York, of course, has both medical examiners and in the dust or chest diseases, dust inhalation and chest dis i eases, a medical board of long standing, and I speak with | pardonable pride, of the great ability in this field. We | had hoped that all three members of that board would be witl^ - 4 ------------- ---------------------------------------------------- r -52A ua today, but professional engagements have kept away from us, both Doctor Imberson and Doctor Whipple, whoa I * sure many of you know* However, we have the good luok to have the chairman of our board of chest consultants here in Xew York 8tate, with us today* I think anything I could say to people, as true to their experience in this field, about Edgar Mayer, would be telling you something that you already know* It has bee^ one of ay real privileges since I came into the field of workaen's compensation administration, to work elosely with him in handling of problems that arise in the oontroverted cases under the different provisions of law, first our old Article 4a of limited coverage, and now the more general coverage that we have of the dhet diseases in workmen's cos pensstlon* He is well kncwn here at Saranac where he has worked long* He known wherever society, learned societies meet to consider this problem* He .la a very stole physician in this field. I present to you the chairman of the lew York State Board of Chest Consultants, Doctor Edgar Mayer* BY DOCTOR MAYER I Whipple* i I want to apologise for Doctor Ambereon and Dock) Unfortunately, as far as Doctor Amberaon goes, yow ji probably know that the College of Surgeons la meeting in New York, and Bellevue has to take its part in the proceedings* \ . ` 1 ftZ S l * S 3 0 IS -- .^ssa - TAKES 1TCM PACK 623. g doctor m a m I vast to opelogi*# ffcr Doctor Aabcrcan and Doctor Bilpplo. Bnfortan*t*l7 , as far as Doctor Aabaraoa goac, you probably knoar that the Oollaga of Surgeon* is aocti&g 1a Bav Tort, and DsUems has to taka it* port in tba proceeding*. __ _____________________ ________________________________ S2A._ I think Doctor Fletcher le here and I just want to let him know that we three, as members of this board, are clinicians. Ve would be placed in that category that Doctor Cochrane, 1 think, mentioned In some grade of the rodent class, 1 believe he classlffcd us earlier in the session. And incidentally, Doctor Fletcher, In terms of our English and American language, when I was Introduced in India a few years ago, I was told to the audience or I was presented as a man who talked American but understood Eng- 11 sh. 1 have made many notes throughout this session, T)d x don't know whether you hawe noticed, but I have been sitting here pretty ateadlly alnoe Monday from nine A* K to the and of the aeselon every day, but one afternoon, be* cause I felt that a board that is placed in an expert eon* eultant oapaeity in this field of dust diseases, should get everything out of the session of this kind, and I think it's been one of the most outstanding sea slant of its kind that could be presented, and it's very obvious that In the past fivs years, there has been very outstanding contribu- tiona that have been made here in advancement in this field by the excellent group that are working here In Saranac and to whom w a ;re all so much indebted. - These notes, I am going to refer to after I read yo_ my few pages of formal script on what our board is, and how ww function and if I may aay that I will,rather immodest^ ly say what I coneider aa our values* I yesterday was appr oached by one of my legal friends, am advisor to lndustsy here who said, Amberson and| Whipple aren't here and you're going to face us alonef And I do do that with much trepidation, but I should probably feel that some representative of labor who would be here would make the same remark to me* I - in Hew York State, prior to 1935, certain occupational diseases were compensated in accordance with a schedule* Silicosis and other dust diseases were not ln*> oluded in this schedule* The laws of 1935, Chapter 250, or 254, extended the Workmen's Compensation coverage to all occupational diseases and sllloosls then became compensable in Hew York State* Because of the laok of knowledge of the extent of the accrued liability, the premium rates for this insuranos ware considered high* In 1936, the law waa amended -- I wlah you'd look these up -- Chapter 887, limiting the oover- age and cosq>enaation benefits,providing for dust control an< prevention of silicosis and other duet diseases, and provide for the establishment of a eommittea of three expert con sultants to study each claimant and to inform the Industrial Consulssloner and the Industrual Board of their opinion as t the findings in such cases* i _82jS* The lav was again amended in 1947 tc provide full benefits for disabling silicosis and other dust diseases under Chapter 431 and at the present time, the lav that dea^s with the work of the expert consultants if - is found in Paragraph 49-a of the Workmen's Compensation Lav* How, as to our functioning, as soon as a claim fo^ i silicosis compensation is filed with the board, It Is re* ferred to the after care service of the Workmen's covpensa* tlon Board* This after care service obtains a chronological history of the claimant's illness, and a detailed ehronology of his smployasnt record* The claim Is brought to the at* tentlon of the employer and the insurance carrier and the claimant is referred, for examination, to a physician des ignated by one of the latter* A hearing Is held In the cat* before a Referee in compensation, and if a claim is cemitre verted by either or both sides, the patient is then referred, to a member of the board of expert consultants* The examination requires uhe taking of very cars* full occupational history from the beginning of the pa-lent1e industrial life, including all aspects of exposure to dust, and it is at this time that the file ie referred to the Di vision of Industrial Hygiene of the Labor Department for an examination of the working condition surrounding the claim ant and for such dust diseases as may be necessary in order i to eavluate for such disturbance as may be necessary i- order 627* to evaluate the dust hazard* In certain cases, the Division of Industrial Hygine summarizes additional data and opinions with reference to past exposures suffered by the claimant* The board exam ination also Includes a very complete physical exandnation, * a fluoroscopic chest study and we carry out the procedure that has been suggested and worked out here to show its vsl1> ue of inspiratory and expiratory timing, particularly ex- ; \ plratory timing in terms of evaluation as an aid in avalua- j i tlon of emphysema, the lung X-rays which are usually in* j plratory* Occasionally ws ask for laterals and obliques, ! and on oocaslon, we ask for planograms* j Sot long ago wo had a conglomerate mass in the lung that could well have been interpreted aa a carcinoma of the lung, but which on planographic study, revealed nodules that had not been seen on the ordinary films, that . i showed us that ws ware definitely dealing with a case of ? wilicoais* | } On occasion, we take electro-cardiograms and Tuoh j laboratory studies are done as are necessary in the opinion : of the examiner, repeated sputum studies or even gastric content, blood examinations, erythro-cardiac, blood circu- I lation rates, and so forth* In evaluating the hazards of occupation exposure,| the examiner, and we are very fortunate in this sense * 1 j v../ -62SU. here of whether we're dealing with beryllium; there wae a very questionable exposure to beryllium, or whether we're dealing with a big sarcoid or whether we're dealing with some other type of unexplained fibrosis, a condition which we can not define without a surgical biopsy. Is disability may be related to all* -gies met in Industry through, exposure to various dusts, we are allowed a consultation opinion of analogies and this Is often recosi siended. If pulmonary disease may be related to the upper respiratory tract, special examination by a nose and throat specialist is requested. Finally, the completed history and the physical examination with the conclusions as to diagnosis and causal rslationshipand degree of disability is reported. Copies of the reports are sent to all interested parties, as well as to the attending physicians and to the medical director of any hospital or saoitorium in which treatment has been carried out. If the claim ie then controverted, the case is referred back for examination to the complete board. The contents-of such report of the comnittee, In troduced In evidence, constltutee prime facie evidence of 0 fact as to the matter contained therein and any of the ma terial of such report Is then subject to examination upon VJ demand. In the event of a claim for death benefits, one l. meaber of the board examinee all available evidence pertain** ing to such claim, including the medical and the hospital | records, the X-rays and other reports that are made during I the lifetime of the deceased, as well as any autopsy findings i and shall render the findings and report thereon* Sow, as to the values of the board, I am putting this very briefly* I think Doctor k'coee presented pretty j well a brief information of the value of such medical boards* i This board of ours, impartial in nature, has proved of great value from both the medical and the legal aspects* Ve are free of any obligation except that of fairness to both em ployer and to claimant* We can freely acknowledge a con- elusion to be one based upon opinion when medical evidence does not permit conclusive objective proof* We are not necessarily restricted to one examination to establish diag* nosis, causal relationship and disability* Frequently eomplete diagnosis can not be made, as well you recognise* until time has elapsed for the development of significant subjective and objective signs* Examinations of all three of us in hearings be fore referees are frequent and are characterised by unre stricted and frank questioning by counsel of both claimant j and employer, as well as by the referee* j i We think that the impartial character of our con- elusions, both in our reports as well as in our testimony, : Ir* 631. have served to gain the hoard the necessary respect of the referees, ae well as that of the counsel on both sides. Prom the medical point of view, we have attempted to set a high standard for thorough and conecientious exam ination in reaching a diagnosis and establishing causal relationship in evaluation of disability. Our work, in part, has servfcd to highlight many of the different clinical problems of industrial pulmonary diseases, ae well as the problems in evaluating the degree ^ of disability in pulmonary disease, and accordingly. wer< o n g the very early onee to acknowledge this and to call freely upon the aid of the physiological laboratory. Ve believe that such openmindedneBS in helping to solve these difficult clinical problems in industry, *7 ultimately do much to define, with the cooperation of the workers here in Saranac Lake, with whom we have been for tunate to he in such intimate contact, we will ultimately he better able to define, perhape, what can be expected in the future by way of aid from the laboratory. During this week, I have been Impressed with a oms of the difficult future problems that will probably arise because of the added information that our British friends have brought us, as well as the information that ha. come rrom Doctor V0rwald and Doctor Wright's laboratories. | Mumber one, I can see where our legal friends w l U b asking 632, ua to define the pneumo... the word 'pneumoconiosIsA which, aa you hawe learned from being at thia eesoion, la now go ing to be In the hands, to be re-defined, in the hands of a new board* I can see where the problems will come up In relation to what we were formerly coneidering aa inert duat^ 1.8 you saw previously on the wonderful sections that Doctor Vorwald and Doctor Fletcher showed us, where focal emphysem^., which would evantually lead to total disability, may well b caused by a sufficient deposit of so-called inert dusts* Certain articlee that I have led - that I have read, are now being clarified in my own wind in terms of disability; these articles on the total disability relation to gravity and carborundum dust -- the graphite duet, I should aay -- that we have been throwing aside, made me again wonder, do we have to consider there are no such things as inert dusts when we have sufficient quantity of dust inhaled* It's going to be a problem in the evaluation of disability, and there again, I feel that we're going to be particularly indebted and be calling upon more frequently, Doctor Leonard Greenburg and hie group in the Division of Industrial Hygiene to evaluate the quantity of dust and the; i hazards that we meet withir an industry ; Doctor George Wright, with Doctor Leonard Bristol, in his presentation of emphysema as an independent disturbance I 633* condition of the lung, separate from that which la derived from industry, has placed before ua something that haa actually been before ua for all these years* We recognise that we can get so-called primary types of emphysema or if you will, emphysema that might be developed from the post-natal maldevelopment of the lung during the period of the continued growth of the lung up to, say, the age of eight,or any interference with the structural development of the lung during that time can well lead, as we know, to bronchiectasis, emphyelatle lung and can so also lead to the emphysema which wa may meet in later years* It is an entity that we have to define in terms oi causal relationships!th the industry, or as a separate en tity distinct from that exposure to duet* These are some of the problems, a few of them, th^t have come up here* The question of cancer of the lung will be remembered immediately, as to the etiological factor when a is exposed to the various dusts* Do we have to now j give serious consideration to the chromates, to asbestos < j I think all the others have been rather well ruled out - as a causative factor, and therefore, a claim for compensation j which tne Germans, ae you have heard this week, have allowed ji in the development of cancer of the lung? These are just some of the problems that I can see are going to become more formidable as - to us, as boards, i 634 as tine goes on. Thank you* (Applause)* BY MISS DOKLONi Thank you, Doctor Myyer* I can only say for my colleagues who are administrators of workmen's compensation from other states, and I see several of them here In the audience, that I wish you the great good fortune of being able to have a medical board chaired by bo distinguished a person in this field as Doctor Edgar Mayer, but don't any of you bid for him, because we want him here in Hew York* How, to conclude this part of the discussion, and then we will have it followed by a period for discussion from the floor, we have, of course, the legal viewpoint* We lawyers always have to come in on this partly, and so we are going to have the legal viewpoint, and wc have a gentle* sum to discuss it, a lawyer who is very well qualified to do so* Ee is the Assistant Counsel of Republic Steel Company at the home offiee in Cleveland, Ohio, but we here in New York know him and have worked with him, and I m surethat many of you from other states also know and have worked with him. Without anything more, I turn ths floor over to him, Mr. A. J* Gentholts. BY MR. GENTHOLTS: (Mr* Gentholts read a prepared paper which is on *1 i file at the Saranac Laboratory)* | BY MISS DO},LON: ; _______ __ _______________________________________________ 655 n r ^'6 3 Danfort Thank you very such, Mr# Gentholts. You have doni what I think is the lawyer1* ueual function of getting all the facta in focua for us to discus* in our discussion, but alnce I*b reasonably convinced that the seats you're sitting; in are not as comfortable as those w e 're sitting in on the platform, I wonder if we might have just a one minute seventh inning stretch. Do you Just want to stand up and do deep breathing exerclsesf )Short reeess taken)* BY MISS POMLOSt I think w e 'd better get along, because we've got another series. I can see it was a big mistake to let you have your discussion privately. I 'll never be guilty of that again. How, we're supposed to have a few minutes for discussion. We're running a little late, so may I have your attention. This first part of the program, which we will now address ourselves to, is the discussions of toe function and value of medical boards and medical examiners ; in controverted compensation cases. I always think it's too bad that you can't have everything before you discuss, because I imagine some of you are going to present questions and viewpoints that might better be presented after you have heard Doctor Braun .*nd Frank B a m a k o and Mr. Sabourin and Harry Klernan who is here also to speak on our second topic, the Presentation of Med ical Evidence in Controverted Compensation Cases, but if we can confine ourselves now to that one question, with all ltii ramifications, on the Functions and Value of Medical Boards and Medical Examiners, I think we will make more progress and I hope you won't mind if I flag you down if I think you are heading over into the second field of discussion where we might better present it in the light of the papers that we will hear there, I wonder if anybody, after hearing these learned discussion*, has any doubt that there is value - you $ay have doubt as to what are the functions and how great is the value. As I said a moment ago, I think Mr. Gentholts has done us a great service by pointing up the experience* end just to get it in focus, Id like to say it seams to me Bitting here, there are three different systems that have been organized. One, of course, is the one that wae found faulty in its constitutionality in Michigan and in Pennsylvania and as long as we do, here, have those due procese clauses, I suppose we shall wish to change our legislation in such * S a way that it will not run the risk of infringing on the due j procese whichis guaranteed to our citicens# j Second, there is, as Doctor Mayerpresented, the j . i kind of board we have in New York, oich is a pernanei.i board 3ZU in the sense of all the year round giving part time to these problems, therefore, getting a background of experience with them, and third, there is the Ohio Board, as Mr. Gentholts has presented it, which is drawn from a large panel and I think he said five hundred physicians. Mow, I think we are all aware, but we should baie in mind that in Ohio, except for self-insurance, all insur ance under workmen's compensation, is under state monopoly system, and therefore, you don't quite have the risk there of finding people who are not wholly impartial* because they have been retained by the insurance companies, and I think we should have that in mind* Mow, Mr. Ted Waters wants to say a word or two, maybe even ten or twenty, about West Virginia's system. Mr. Waters* BY MR, WATBK3I These remarks will be quite brief* My primary practice la in the State Maryland there and the medical board of that state haa battered me down so many times that X J frequently cross the state line into West Virginia and try my efforts there* I'd like to tell you just a word about | the practice before that board which I think is quite unique Art Gentholts has not referred to that in the course of his remarks, and that's the reason I asked for ths opportunity to say this word* Under their procedure, claimants are sent to the City of Charleston where they are hospitalised for a period of three days under the direct supervision of the members o1 the medical board. Physicians on behalf of the employer an<!. the claimant ere permitted to participate in the examination of the claimant, and to testify before the board with reapect to his condition* T hey then render their report to the Commie el oner and the Comsdesioner, after a formal hearing where the clei: ant and hie doctors and the employer and their doctors are heard, render* a disposition# My pr&ctlee there hasn't been much more success-* ful than it hae been before my good friend, Hathan Herman, sitting here in the front of the hall, but the point I mean to make is this, that they do participate as examining doe* tors of the claimant and the universal practice, if you please, before the board, is for the Commieelon to sustain the findings of that board# I happen to be one of those at torneys who have, on occasion, two occasions aeveral years ago, taken their opinions to the coirts, to my sorrow# I simply wanted to add that word about West Virginia. BY MISS DON LON: Doee someone want to apeak further on this subjecljt i Hill you give your name, please for the stenographer, and your 5-*,,ate? BY DOCTOR HERMAN: Doctor Herman, Maryland. Don't you mean the Silicosie Board of Weet Virginia? BY MR. WATERSt That's right. BY DOCTOR HERMAN I You said, I think, the medical board. There re cently haa been a board appointed for the study of occupa tional diseases rather than silicosis. BY MR. WATERS} That's correct, my remarks were directed to the subject that's under discussion, pneumoconiosis# BY MISS DOHLOH: X don't want to close off discussion, but we haws to have some Interesting papers here, and we are running a little late, bedauae we started late and I'll be glad to come back to questions and discussion on this point, a little later if that's your pleasure. Therefore, I would like to begin this part of the program the- has to do with presentation of evidence in controverted compensation cases. As you noted, the discus sion In the first part of our program got away from the con troverted ca3ea and over to all silicosis esses and I hope that we, at least in our discussion, will not confine our selves to controversy, but to perfecting a record which will eliminate controversy perhaps, so far as that ia possible# The first speaker is to present, I assume, the medical view, with regard to the presentation of medical evidence in compensation cases, in the pulmonary diseases, and he is now the medical director of the Industrial Hygleno Foundation of America, but only recently has gone to that distinguished position from a background as medical director in industry, and in an industry where he has had wide ex perience with the industrial chest diseases# 1 present to you Doctor Daniel C# Braun of Pitts burgh, now the medical director of the Industrial Hygelne Foundation of America# BY DOCTOR ERATJKl Doctor Braun# Miss Donlon, Ur. Waters, Members of the Symposium] It is my misfortune not to be able to attend the earlier sesslona of this meeting and from e verything I have heard, this has certainly been outstanding and verysuceeasful# Doctor Vorwald and his associates should be congratulated# The caliber of the papers earlier this morning makes me feel a little inadequate from the standpoint of adding anything to them. However, during my tenure aa medical director of aj i large corporation, I several times had the opportunity to J watch my medical colleagues spend some very uneasy moments j as medical witnesses, expert witnesses, in controverted