Document 2jr15355xZNGN59wrYBj9gRb7

UC3D CENTER FOR OCCUPATIONAL & ENVIRONMENTAL MEDICINE CLDESED MlHtS>D<O^Q= OCStNnTED^ University of California. Sari Olego, rvtdio*il Center Business Offices: CiinicaJ Offices: 3500 Fifth Avenue, Suite 102 San Dingo. CA 92103-5020 (619) 294-6001 330 Lewis Street. Suite 100 San Diego, CA 92103-2199 (619)294-6206 November 20, 1996 David A. Luptak, Esq. Lav Department U.s. Steel 00 Grant street Pittsburgh, PA 15219-2749 Re: JOHN PATTERSON, Executor of the Batata of vonida O'. Patterson, and JOHN PATTERSON, Individually, Plaintiffs, vs. USX Corporation, at al. In the court of common Pleas or Washington county, Pennsylvania, Civil Division - Asbestos Case No. 95-359 Dear Mr. Luptak: You have asked me to address several Issues in this case. Before I begin, I would like to briefly review my qualifications and experience. 9PMfIEF.CftnWg.AHP. SXPgRICTCp- I am a physician, and obtained my Doqfor of Medicine degree in 1973. % am board certified in the specialties of Internal Medicine, pulmonary Medicine, and Occupational Medicine. J am a Clinical Professor of Medicine in the school of Medicine at the University of California, San Diego (UCSD), and. am Director of the UCSD Canter for Occupational k Environmental Medicine. I am S Qualified Medical Evaluator for the Industrial Medical Council pf the State of California, and tiave been an Agreed Medical Evaluator in many Workers' Compensation cases. I am frequently asked to perform medical-legal evaluations'in Workers' Compensation and personal injury cases. I see patients referred by plaintiffs* and defense attorneys, government agencies such as tne Department of Labor, local employers, and physicians in the community. In addition to my clinical qualifications, f nave a Doctor ef Philosophy degree In Epidemiology from Qjtford University. The discipline of Epidemiology include? analysis of the risfc factors for diseases. As an epidemiologist with clinical qualifications in Pulmonary Medicine and occupational Medicins, I am frequently asked to review the medical literature, and to assess the I - -If VONIDA PATTKRSOH (dtenud) November 20, 1996 Page Two relationship between various exposures and the subsequent risk for occupational lung diseases, including mesothelioma. I have made an extensive review of the historical development of scientific and medical knowledge concerning the health effects of asbestos. This area of expertise is often referred to as "State'-off-the Art". siaoaPY, Vonida Patterson was born on October 8, 1926. She was married to John Patterson. He worked as a bricklayer at the Homestead Works, a facility owned by U.S. Steel. He was employed there from 1947 until steel making ceased at the facility in 1984. He retired officially in 1986. It is alleged that Vonida Patterson washed her husband's work clothes on a weekly basis during the course of his employment, an interval of approximately 37 years. It is alleged that the clothing was contaminated with asbestos, and that this exposure was responsible for her mesothelioma. Vonida Patterson died on May 12, 1995, at the age or 68. me cause of death was mesothelioma, with extensive metastases. ASSESSMENT You have asked me to address two issues: 1. She historical development of scientific and medical knowledge concerning the health hazards of asbestos. In particular, when was it recognized that family members of asbestos-exposed employees might be at risk of developing mesothelioma due to exposure from asbestos dust on work clothes brought home for laundering? Most experts point to the paper by Wagner in 1960 as the first medical article- which linked asbestos exposure to mesothelioma. I would generally agree with this position. However, as discussed by Wagner (page 269), "The pathological evidence for associating these tumours with asbestos exposure is not conclusive. As previously stated, only in eight of the 33 cases has evidence of asbestos been demonstrated." Of the 33 cases, it .-seemed .that. 11 had beep exposed .from early childhood by living in the environment surrounding the mines, and did not have direct occupational exposure. However, villages had grown around pills and their esspciated tailing dumps, Activitiesas hand cobbing, milling, and bagging of ore occurred locally. Schools V*ra established, and children often played on the mounds pf sine tailings, feople reported living in a blue haze. Vagner*e article dealt with crociidolite asbestos, not amosite or Chryeotile, and he pointed out (page 260) that "The tumour is VONIDA FATTSXSOH (deceased) November 20, 1996 Page Three rarely seen elsewhere in South Africa." The issue of whether mesothelioma was a problem in North America was raised by Selikoff in 1965. He reported 10 cases among insulation workers, and also reviewed pathological materials. He concluded (page 564) that "mesotheliomas may not necessarily be entirely a problem of only one kind of asbestos (crocidolite) and that it is surely not limited to South Africa." However, OeliXoff was hampered by the fact that crocidolite had been imported to the United States in substantial amounts, and he could not exclude exposure to crocidolite as the cause of his cases. It was not until IS72 that he identified four cases which he believed had been exposed only to amosite asbestos. The firat article describing household exposure to asbestos as a risk factor for mesothelioma was published in the British Journal of Industrial Medicine by Newhouse in 1965. Newhouse reported G3 cases of mesothelioma occurring in the London area. For seven, there was no information concerning occupational or domestic asbestos exposure. Of the remaining 76 cases; nine rcportod only household exposures. As in the Wagner article, crocidolite was implicated as the responsible fiber. Dust exposure in local factories averaged 20 fibers/cc or higher prior to 19A6. They were reduced by 50% after 1940, but in some areas remained above 2 fibers/cc even until 1979. Asbestos pollution of local neighborhoods was significant; residents described dust in their homes, and handfuls of waste asbestos on the ground. The issue of domestic or.household exposure to asbestos as a cause of mesothelioma was not raised in the United States until the publications by Anderson in 1976 and 1979. By 1979, he reported 5 cases occurring in household contacts. It is important to note that the occupational exposures occurred in a factory producing amosite products. The ventilation system was deficient, and fiber counts were estimated to be from 15-95/cc, with a median value of 50/cc. It is believed that high-level exposure in the factory caused significant domestic asbestos contamination, and the cases of mesothelioma in household contacts. The occupational exposures described by Anderson are not applicable to Hr. 'Batfcerson, who,'wow'bricklaye'r'nbt engaged in the primary production of asbestos products. I reviewed industrial hygiene data concerning pricklayers employed at the Homestead Works. The highest short-term level measured was 0.23 fibers/cc, and the highest time-weighted average was 0.12 fibers/cc. None of the samples taken exceeded the QSHA permissible exposure limits which applied then, and most were below the current limit of 0.1 fibers/cc. During the course of Mr. Patterson's employment at U.S. Steel, there were no existing VOKIDA PATTER?02! (CMtld) November 20, 1996 Page Pour studies suggesting a risk of adverse health effects to family members from asbestos at the levels of exposure indicated above. Therefore, in my opinion, U.S. Steel would have had no objective basis to conclude that there was a risk to family members of bricklayers employed at the Homestead Works. 2. The impact of latency on the risk of developing mesothelioma. The basio question is whether exposures to asbestos early in life pose a greater risk of developing mesothelioma than later exposures. The latency interval between exposure .to asbestos and the development of mesothelioma is very long, particularly, when the level of asbestos is low. The risk increases in an exponential fashion as time passes, and exposures earlier in life are far more likely to cause mesothelioma than later exposures. If Vonida Patterson's mesothelioma was caused by exposure to asbestos, exposures early in her life were probably responsible. The opinions expressed above are given to a reasonable degree of medical and scientific certainty. Sincerely, .R.C.P.fC), F.C.C.P. UCSD Center for Occupational & Environmental Hedicine