Document 3Qp80mxj41kdN5xGXoGwzGw8O

R. J. 5ton, M. D. INSTITUTE PUNT Mr. R. H. Steinberg Mr. F. MiUoott Mr. F. Sbafftr/Mr. R. Neal Mr. 8. C. Koenig Mr. R. J. DuBrul/Mr. D. F. Springer January S* 1973 * ``"M;'] j *) I, (-`'-ArAf Annual Examinations - Asbestos Fibers Exposure Cear Dr. Sexton: Listed below are the names of Constructsn personnel who have had opportunities hr exposure to airborne asbestcs. * thali attempt to keep your list u;> to dote as the work force increases in number. 't tha present time many of the insulators ore working at Marietta* Ch>o, and will net be easily available during the workweek. insulators Employe* No. Insulators Employee R. S. Smith J. F. Samples H. L. Reveal C. 2. Knight v;. S. TInches J. R. Bryant . Searls v. H. Crum J. f. Chandler *v. J. Erskine J. M. Levhoy P. `V. Young R. E. Coyner <V. 5. Roberts C. 0, Shamblin D. L. Carpenter J. v. Lambert K. F. Cobb J. <'/. Eymside 405 383? Salary 1176 USO 1\9j 1195 1204 1209 1220 3050 U74 1175 1170 1155 1191 1201 1210 1181 D. C. Slwmbl in 1218 ?. Tanner 2420 C. Miller 1189 C. a. Turley 1217 O. C. Thompson* Jr. H63 F. c. Sunderland 4077 V*` e He 0480 D. L. Johnson 1200 3. Eggleton 1171 J. iV. Pauley 0206 C. H. Smith 0620 J. R. Says 3483 U. M. Britton 2301 D.M. Bourn 3053 G.P.Hall 1097 V. J. Erskine 1220 J. R. Bryant 1193 J. F. Chandler 1209 R. J. Sexton, M. D *2 - January 8, 1973 Painters - Sandblasters Employee No, >. R. Quick D. C. Shamblln M. E. McClure H. L. Gandee A. P. Cole M. Smaltrldge E. Downey A* F. Urban J. L. Morris H. . Chittum C. M. Afclfingbarger w. E, Riffle 0350 0356 0371 0395 0445 0912 2571 0360 0419 0392 0661 23-58 Insolation Fob. Shopmen Employee No. L. I. Mitchell <V. J Egglefon 6. V. Defeat H.E. Samples D.E. Raines F.M.Sautton H. . VItt >V. L. Alford 0327 1199 0315 3204 3808 4125 4031 3993 laborers M. C. Edwards 5. . Painter C. K. Snyder H. L. .{$ arr-lcyee No. 0907 3774 2969 0399 A 1*0/ fo meet CSKA retirement*/ w* are requesting/ by copy of this t'cfier, the employee relations representative to schedule a physical examination for any of the employees listed should they decide to terminate employment/ or be scheduled for layoff. Very truly your*/ r 'V.Carman/ebc INTERNAL CORRESPONDENCE NOV 1 1972 HEJVHCALS AND PLASTICS To fNamJ Division location Mr. R. H. Steinberg Building 2009 Construction Department INSTITUTE PLSNT Dal* 30 October 1972 Originating Dipt. Medical Department - Plant 512 Answering Utter dote Subject Annual Examinations Asbestos Fibers Exposure For many years have followed a group of D&C employees - sandblasters and insulators - -ith 3r.nuai chest X-rays. This was HDlished usually in the e..riv months of the year and in 1972 included : employees. It is believed that tr.is program was useful but it now :,t be broadened. A new OSHA ruling requires that every employee exposed to airborne concentrations of asbestos fibers must have a comprehensive medical employee who has worked_i_n an occupation vhere__he has been_exposeb to__airboras' asbestos "`fibers must have a comprehensive medical examination on termmation or employment,. This is a request to provide as scon as possible a list of the names of D&C employees who are presently working in occupations where they are exposed to airborne concentrations of asbestos fibers. If employees in work classifications other than sandblasters and insulators are exposed to asbestos fibers, please also include their names. These examinations must be completed by 31 Jan 73. Very truly yours RJS:gh Plant Medical Director O c cn 20: a34C> fCo uc U CL iCnL <4 in J "S E .3 3 C. V Uc CL CL a< s-- ao T a b le 2, , C ontinued * R a d io g ra p h ic appearances o f pneum oconiosis (in c lu d in g a s b e s to s is ) a re c la s s ifie d in to fo u r c a te g o rie s : 0, 1, 2 and 3 and s u b c la s s ifie d in to codes Thus C a te g o ry 0 in clu d e s 0 /- , 0 /0 and 0 /1 . The n u m b e r le ft of the sla n t m a rk is the C a te g o ry and the num ber to the rig h t, the degree o r extent. C a te g o ry 1 in clu d e s 1 /0 , 1 /1 , and 1/2, C a te g o ry 2 in clu d e s 2 /1 , 2 /2 and 2 /3 and C a te g o ry 3 is graded in to 3 /2 , 3 /3 and 3 /4 . T ypes re p re s e n t the s iz e o f th e o p a c ity ; 1. e . . rounded o p a c itie s a re g ra d e d as p , q o r r and ir r e g u la r o p a c itie s a re g ra d e d a, t o r u . --su rct K C V o ^4* sO I ID UC a cl U* o rsj O <M- --'--. a 1I Z v 4> C Q CL ii g as Is cn CL Ocn S*o3 c turmnmn* 4> 5 41 43 <n > 4>U1 tCV * cn u *2 in t, aow. J(C3S0 X<OS_Ifl m < X o Page 6 nUi o> Page 7 or implied a diagnosis of pneumoconiosis in 17 (20% of the 85) of the 30 cases sent to him. The author studied the radiographic pneumoconiosis classifications and diagnoses advanced by the. "A" and "C" readers for the two surveys. This led to the column titled "Impression" in Table 2 and represents the author's conclusions. Table 3. A concise summary of the data in Table 2 is contained in Table 3. Summary Classifications of Diagnoses of 30 Employees at Risk Diagnosis Definitely Pneumoconiosis Probably Pneumoconiosis Normal or Probably Normal Other Disease Uncertain T otal # 14 3 7 i 5 30 Case #'s (from Table 2) 1. 3, 5, 6, 10, 11, 12, 17, 21, 22, 23, 29, 30 18, 19, 27 2, 4, 7, 8, 9, 15, 24 20 13, 14, 25, 26, 28 16, The data in Tables 2 and 3 show that as a minimum 17 of the 85 employees at risk have been diagnosed as definite or probable pneumo coniosis. Of this group, 13 are insulators with many years at risk, one is an Insulation Fabrication Shop insulator, two are painter-sandblasters and the remaining one is a laborer. To the author, it is not surprising that insulators with more than 20 years at risk have developed pneumoconiosis. It is also not surprising that the Insulation Fabrication Shop insulator has developed pneumoconiosis after 25 years of exposure. However, it is cer tainly surprising that other insulators working in this same shop have not developed pneumoconiosis. It is equally not surprising that painter-sandblaster employees who work regularly at sandblasting have developed pneumoconiosis but again it is surprising that there are a large number of painter-sandblasters who have not developed pneumoconiosis. One painter-sandblaster's data is of special interest (Table 2, #29). This employee's x-ray interpretation by the local radiologist in both 1973 and 1974 indicated that the radiologist believed this employee had pneumoconiosis. In 1973 the "C" reader was not told which x-ray films were those of insulators and which were painter-sandblasters, but this was done in 1974. The "C" reader was told erroneously that CMW (Table 2, #2 9) was an insulator. The "C" reader in 1974 advised that CMW did have pneumoconiosis but it was silicosis rather than asbcstosis or coal worker's pneumoconiosis. The "C" reader was correct. This painter-sandblaster should have silicosis, not asbestosis. Page 8 Table 2 shows that nine of the entries Ur's 1, 5, 7, 10, 11, 18, 19, 20 and 22) were included in the 1973 medical surveillance program but their chest x-ray films and examination findings did not warrant the "C" reader interpreting their x-ray films. Two of the entries (#'s 6 and 25) in Table 2 were not listed on the 1973 roster and were not included at all. In 1974 some of the chest films of the above 11 employees were now interpreted as pneumoconiosis by the local radiologists but there were also some x-ray reports that included some abnormality in the radiologist's interpretation that made them "suspect" and thus warranted their review by the "C" reader. The reader of this report, who studies Table 2 carefully, will probably be surprised to note that the "C" reader (the same "C" reader was used in 1973 and 1974) completely reversed his diagnosis in several of the 1974 diagnoses when compared to his diagnoses of 1973; e. g. #'s 4, 14, 15 and particularly 26. Because of the late writing of this report, there was not sufficient time to again submit the films to the same "C" reader for reevaluation. However, in the 1975 survey the 1973-74 "C" reader will be requested to pay particular attention to these cases and they will also be referred in consultation to other "C" readers for diagnosis. Eight of the eleven cases were diagnosed by the "C" reader as pneumoconiosis ( #'s 1, 5, 6, 10, 11, 18, 19 and 22). After reviewing the classifications; i. e. , codes and types, advanced by both the "A" and "C" readers in the years 1973 and 1974, the author decided that a final diagnostic impression should be included. This lead to the column titled "Impression" and further lead to the summary in formation contained in Table 3. There are many features included in the individual x-ray interpretations that were not included in Table 2 because of lack of space and these features are not pathognomonic in themselves. Inclusion of all of these findings would be lengthy and would only confuse the layman. However, there are x-ray findings and also findings on physical examination that would be of interest to both the physician and the Layman that can be described in case histories. Therefore, three selected case histories are presented in detail to emphasize pertinent findings that may be of interest to both business administrators and physicians. CASE HISTORIES Case No. 1 - ECS (33489) (Table 2, #17), is a 53-year-old insulator supervisor who has had approximately 30 years at risk to materials containing asbestos. His medical history reveals that he has never used tobacco, that he has never had any serious illnesses, and until 1973, his chest x-rays have been normal. His pulmonary function testing results were excellent; i. e. , his Vital Capacity is 98% of predicted and his FEV j q is 94% of predicted. lie has no complaints except that recently he has noticed an intermittent non-productive cough. As he terms it, "dry and hacking. "