Document 3JBG4KGbw5J7kawgkK2byopX0

FILE NAME: Saranac 7th Symposium (SSY) DATE: 1952 DOC#: SSY052 DOCUMENT DESCRIPTION: Text of Presentation by Mr. Wagner Mamin* W H u m m u w r Gtonw O - M u t n a m i w i J.Diwiy Doniin *********** Iter M unnmt,****** f**ii d s ssociation o fG' asualty andSurety Qonyysnies CASUALTY MTATTMINT AkNicOhR-CkWd Mc LMwYKcOmH* XMM>in>wnTM****** SIXTY JOHN S T R U T N E W YORK 3&N.Y. September 12, 1952 Dr. Arthur J. Torvald Director, Tbs Trudeau Foundation and The Saranac Laboratory F. 0. Box $51 Saranac Lake, Bev York Dear Dr. Torvald: I a s enclosing tvo copies of My paper to b e delivered on the first day of the syapoelm. X an sorry I could not get this to you any sooner. Yeiy truly yours, Enc. C asu alty DeparUaent iifeiu D E F U in o a OF PSHBOCOHIOSIS - HOKE T.gTJT. ASPECTS / Paper Read $y Richard C. Vagner, Manager, Casualty Department, Association of Casualty and Surety Companies, at Seventh Saranac Symposiua, on September 22, 1952, a t The Sart -c Laboratory, Saranac Lake, lev Tork. The question of definition o f medical terms would aeea, aa a setter of first impression, to be a problem excluaively for the medioel profession. Cer tainly it can be conceded that it is primarily a medical problem. Obviously that ve the riev of the sponsors of thia seating, for her# I a s the only attorney in a group of five eminent physicians. However, scmevbat closer study reveals, as is often the case in the field of occupational diseases, that medical definitions have important, often vital, bearing on legal rights both o f employers employees. This is especially true where such definition#, and any dafecte they aay contain, are incorporated into any statute. They are aleo of importance where they form part of the testimony or influence the judgment of a medical witness. Let me illu st rate. Ve are here Interested in the definition o f the term *ruanmooonlosis* and those of the other (IIBeasts or conditions that fall within the broad scope of that general term. I n K e v Hampshire for example, the a Vorlcsen* Compensation Lav provides coapena ition for certain listed diseases, inclndirg "silicosis and other pulmonary duet dieeaeee." Vhether a particular condition can be c *sd as a pulmonary dust dlse&sa will determine whether or not that particular individual will receive compensation therefor. The ultimate determin ation la each a case is very likely to rest on the medical testimony which is pre- steted. Does beryllium poisoning, for example, fall within this category? Vbt about ar allergic reaction to let u s say flour dost? 1 medical expert confronted with tie necessity o f expressing an opinion on the point eight be inclined, if my experience la any criterion, to a liberal interpretation in order to enable the claimant to receive compensation. Vbat -a- `, i would his testimony be, however, where i n s W of resulting in the granting of ; compensation, classifying a particular condition a. a polnonaxy dust disease would i | result in reducing or possibly barring the payment of compensation, kt no doubt | w of you know, many states have special provisions with respect to silicosis j and scat of the other dust diseases. There are provisions for graduated scales of benefits, the so-called escalator clauses, whereby compensation for disability occurring shortly after the effective date of the law ie H a l t e d . Special re quirements ae to exposure or time limitations are also provided. The particular : facts of a specific case night well not fit those particular requirement*. let j consistency is necessary. 1 different answer to the ease question can hardly be . j justified because o f the difference in the effect such an answer would have. A t the seme time, it might be well if in f o r m d a t i n g the definitions o n which opinion, bmvs to be based, the legal effect of the m s e of particular language s^r well be ) given some consideration. Their effectiveness as usefdl tool, in the solution of I practical problems would thereby be enhanced. j 1 have indicated that the problem of definition. 1. of significance under m j schedule type law. It i. of importance also, particularly with respect to dust j diseases, under a lav providing broad occupational disease coverage either with or j without definition. As I have mentioned, a number of steles have found it necessary because o f the special nature of the dust diseases, to include provisions specifically i dealing with such diseases which differ from those relating to occupational diseasm# generally. A general descriptive tern is necessary to describe the diseases to which these special provisions should be applicable. It the same time, euch a term should not be so broad as to be applicable to conditions to which those s o c i a l pro visions should not apply. The term would have to be general for if specific diseases, say silicosis or asbestosis, only are mentioned, avoidance of these J special provisions may be attempted by alleSing disability from one of the other dust diseases. - 3The legislative history of such provisions in Michigan is interesting in this connection. Vhen provisions for compensation for occupational diseases vers first enacted in 1937, the schedule of such diseases included three different references to dust diseases. One vas stone workers or grinders phthisis caused ty quarrying, cutting, crushing, grinding or polishing of stone, or grinding or polishing of natal. The other vas silicosis caused by mining. The third referred to pneumoconiosis caused hr quarrying, cutting, crushing, grinding or polishing of setal. It is apparent that the Legislature in this instance was having some diffi culty with definitions. In 1943 the schedule was repealed and a broad definition substituted. In that state the special dust disease provisions both before and after the 1943 amendment referred to "silicosis or other dust disease." Tram the use of the word silicosis the inference 6eas plain that the disease must be pulmonary, let I believe the special inclusion of that word would have been desirable. Some loabt as to the scope of these provisions, however, must have existed for in 1945 dien provisions for periodic physical examinations were added these referred to "silicosis, pneumoconiosis or other dust disease." These, I nay add, have sine# been repealed vhen because of lndefiniteness they were held unconstitutional ty the court. This legislative history is of interest as indicating the difficulty ex perienced in the use of terms i n just m e etato. It eight be noted further that ihlle the schedule was in force in Michigan there vae considerable queotion whether rilicoeie vae compensable in a n y industry except M ng and whether the term etr^ocouiosiB vae broct enough to include silicosis, Sutter vs. Kalaaasoo 8tova -ad Furnace Company, 1941, 297 Mich. 226, 297 H.V. 475; Gerleeits vs. Lakey Foundry _nd Machine Company, 1947, 319 Mich. 229 , 29 H.V. 2d 856; Kercante vs. Michigan Steel Casting Company, 1948 , 320 Mich. 542, 31 H.V. 2 d 712. While ve are discussing terms, I would like to express a word of caution. -i - ,, . condition ht. . t a d there 1. . t - a U n c , " W J* - 40 f M l " i . d ibU n , and that I t .hoold K 0 - p .n d d .. HUT U ""> " * .... t. to cropping * - t h * > < fr~nney, hot. b . d d to 0 - - t h i n th. , ,, . d . P . of th. -cod pswaoeonionla. If that tor. or an -- t-- l* ^ witboot adatpat. dafinltion 1 . 1*, J condition which H h t b. d d to d a within It. aoep. t. da-- to b. o t - p o o d l o . I*t. 1" " * " *U r of th... not ~ o . l d . r - to b. d l - b l l n g . Th. fifth - t i n . o f < * * * ' Dictionary (19U) d*fia* pneraonokoniosis aei U general tarn a p p l l - to chronic lndoraticn or A M i n f l - m U . of th. long. do. to th. Inhalation of du.t. farloo. -- . ar. f t TM to il aooording to th. kind of dual .analog th. I r ^ a U o n . a n t h m e c l a , that dn. to the lntalatloo of e d - d d , .id.ro.1., that do. to l n h a U U o n of o c t a l U c dost] . d i e d . , that do. to th. i ^ -- tlon of -- d * * * la js a n a lg M v a il f .o l th at - 1 t h ... condition. a r . or a h d d 6 . - TM ~ U . . l o t o . lo o k , h o w d r , a t t h . 1919 M ltlo n a p p r a a tlf of th . . book ooh taiown aa n u W W . A d d N o tio n ^ n r a t Id ltlon . P n o oo o old . la defined a e t Chronic liflB -a tlo a of th. long. o a o d bf th . I n h 0 . t l of d a *. g H of th. r -- ognia-- f e d ar. do. to -- d d u t . . ( I x r l f U o o . 0 , th . bronchial t r c . nor .o a t . Infection. r a t i n g f r o . InhaUUon of organic d o s t, i n classed . . pnesrsnaoconlcnee.) The pr-- d n a n t r -- otlon 1. fibrosis, which n r l i i In hyp. with th. .biologic dost. 8111ool. -- ..bootools .r. th. .alst f o r - of p n d o n o c o n l o o l s known to can., d l w blllt,. Other fore., known . a benign poeunonoconlooe., in which the reoction li 11-- t - to th. a t r o d tlo., are enthraco.l., doe to carton d c t , .ld.~,l., do. to iron dost, d o l e d ., do. to rrbl. do.t, and ta r ltd ., do. to taolu. do.t. A" ' tarylld..* - 5I think you vill agres that there is considerable difference in the effect these two definitions would hare on laymen. That ay point is not academic, is eridenced by a law recently adopted in H a b e a s . This law enacted in 1951 (Act Ho. 180, Lavs of 1951, effective June 29, 1951) provides compensation only for "occupational pueumonoconiosis." This is defined asi "A disease of the lunge caused by inhalation of ainute particles of duet over a period of tiae and which said dust is due to causes and conditions arising out of and In the course of the employment without regard to whether or not said causes or conditions are inherent in the employment or can be eliminated or reduced by due care on the part of the employer. The tens 'occupational pneuBonoeoniosis' shall include, but without limitation, such diseases as silicosis, siderosis, anthracosis, anthra-sillcosts, anthraco-silicosis, anthraco-tuberculosis, tuberculo-silicoeis, silico-tuberculoeie, aluainosis, and other diseases o f the lungs resulting from causes enuasratad in this section." Please note the inclusion of siderosis, anthracosis and aluainoeis. I would dis like to attempt to define with any degree of ct talnty the ecope o f this lav. let at least eoae of you nay be called upon to give an opinion whether or not a specific condition is or is not "occupational pneuaonoconlosls" within the **< of this definition. Setae of the other statutory references to dust diseases a a y be of interest. In Few Tork the reference is to "silicosis or other dust diseases." A rather interesting situation arose under this provision. In 1942 an employee claimed and was awarded compensation under Article 4-A, since repealed, relating to dust diseases. The claim was for disability alleged to have been suffered from exposure to dust freat vacuum cleaners, Stureaky vs. Strausaaan, 1941, 263 A.D. 771, 30 H.Y.S. 886. After a period in military service he reopened his case. He now contended - 6 - that his condition, asthma, was not a dust disease hut a n "occupational disease.* The court held that its original decision vas not res adjudloat* and on the basis of the nodical evidence presented, a f f i m e d an award under the broad occupational disease provisions. Apparently, when the original claim was presented, there was doubt whether the claimant's condition was an occupational disease or an ordinary disease of life. The contention that it was a dust disease probably vas thought to strengthen his case. Once the occupational nature of his condition was established, apparently to avoid the H a l t i n g provision! of Article 4-A, he was able successfully to reject this theory (id. 1948, 273 A.D. 1036, 78 I.T.8. 2 d 633) I Bay add that i n Missouri, on the other hand, asthma from an allergy to wheat dust m s held not to be an occupational disease since it vas due to the claimant* s sensitivity and not to the basards of the employment as such, Sanford vs. Valler-8plas Milling Co., 1950, 235 S.V. 2 d 92. . In Ohio the silicosis provisions are also applicable "to other occupational diseases of the respiratory tract." This language seems somewhat'broader than the reference to duet diaeasea or pulmonary dnat diseases found in same of the ether lavs. It may, for trample, well result in a different construction than that which was reached in Sew Tork. In Ohio I t ie interesting to note that berylliosis is specifically excluded from these provisions although the medical experts known as silicosis referees are specifically given Jurisdiction with respect to this disease. A lav providing compensation for occupational diseases vas enacted in Louisiana this year. This contains a list of compensable diseases, Unwinding asbeetosis, sllicosiB and pneumoconiosis. In view of the fact that the courts administer the Workmen's Compensation Law in that state, the interpretation of this term may well present sotra problems, in the solution o f vhiph doctors will have to i play an important part. Besides the definition in Alabama, Florida comes nearest to having a - 7definition of duet diseases in the statute itself. In that state, compensation is provided for occupational diseases under a broad definition. It is there further specifically stated that 'disability from silicosis, asbestosis or any dust disease shall be caused only from the characteristic fibrotic condition of the lungs caused from the inhalation of dust.' Thus here v e find vith reference to dust diseases a specific reference to fibrosis which you vill have noted is lack ing in soma of the other statutory references. There are, of course, a number of states that make specific mention, either vith or without definition, of silicoeis and asbestosis. These definitions are fairly similar in wording although they do differ in exact language from state to state. Some include a specific reference to nodulation with respect to silicosis. Others refer to the 'characteristic fibrotic condition of the lungs caused by in halation' of silicon dioxide dust or asbestos duet, as the oase m y be. I have not beard of any particular difficulty arising from these definitions. Some thought might be given, however, to whether or not the reference to nodulation should or should not be made. ^ have endeavored to point to some o f the more important legal problems that arise through the use of terms without definitions or where the definitions used are not completely satisfactory. In illustration, specific reference to the provisions of the lavs o f the various states and experience thereunder has been made. While these are legal prohleme, lawyers of necessity must look to the aedical profession for their solution. I believe it would be of mutual benefit if in formulating such terms and their definitions the aedical profession kept some of these questions in mind. Is there a general descriptive term that would cover sllicosia and other similar dust diseases and, at the same time, exclude Don-disabling conditions? What 1 b and what should be covered under the term pneumoconiosis? These and other questions will require an answer. It would be most helpful if such answers were taseu on informed opinion reached after mature deliberation.