Document 4aR3pkgQKRrg1Dr4oRnkdXNKQ
SM-32 <REV S-70)
Shell Oil Company
Interoffice Memorandum
NOVEMBER 9, 1990
FROM:
LOUIS C. WADDELL, JR., M.D., MEDICAL DIRECTOR, CLINICAL MEDICINE CORPORATE MEDICAL DEPARTMENT
TO: E. SHEPPER, M.D., MEDICAL DIRECTOR DEER PARK MANUFACTURING COMPLEX
SUBJECT: PULMONARY REGISTRY REVIEW:
EMPLOYEE NUMBER
In our routine review of exams, it was noted that the chest X-ray report concerning the above employee was interpreted as showing possible noncalcified pleural plaque on the left. The indication was that he is not in the asbestos surveillance program, so a B-reading was not done.
However, we should pursue this further. Would you please complete the
Pulmonary Registry form for .
and send that form along with his
chest X-rays to me for review.
Thanks for your cooperation. If you have any questions, please give me a call.
CT9031301 - 0001.0.0
LAM 032076
ABS-055469
NAME Of FN"
S-13200 (4/89) 006061
PULMONARY REGISTRY
1 EMPLOYEE NUMBER !
LOCATION
CONFIDENTIAL - MEDICAL^"
3>Pmc-
REASON FOR REVIEW
1. CHEST X-RAY REPORT INDICATING: al Pnssihle pleural ah/wmslity Cdie 1
<1 pf^VCjf
0-a W"; po<;<;4lv 4iy o~4r
Lh.
7. Has the employee had a job where it is possible, or rikely. that he has been exposed to some other agent known to cause a dust disease of the lung, (e.g., Silica, etc.)? If so, list
.--.
yes Hno -- 1--1
b) Posable fibrosis
2. PULMONARY FUNCTION TEST ABNORMALITY:
a) FVC less than 75% of predicted hi C
( P7~~
$;*?_ |<n$o)
___________
8. PLEASE UST JOB TITLES AND NO. OF YEARS IN THAT POSITION
LiA<? - OviSnUr H70-S1/. fqrdy^v,
SlL
t / ------------ ---------- --
~PoknruC - ^\r*\)cJt-r~
- C.'T
\C\5 5--Q>L~
hi Other
| . Other reason ,orre"ew
r-- \ lyweeU/Ei)!
9. Is there any history of other respiratory illness that could account for (he X-ray abnormalities under r consideration? If so, list
"P/e.ur.'fvq' 1^77
^ pro<.h}f
1
m/ i--i yes |__ j NO
)
4
MrV-cL
HSS
S. Has the employee worked In a facility that used asbestos so that it Is possible that a pleural plaque could be related to job exposure?
6. Has the employee worked at a job (e.g., bricklayer, insulator, etc.) for a sufficient time (usually at least 10 years) for it to be likely that asbestosis could have developed?
d. ^ i4- rScUo CRen-ly Ip; Lc
____ . 4 / . .. .
^~
v\x l--l YES | j NO
10. Is there a history of exposure to a pneumoconiosis
r-f^/
producing agent outside of employment at Shell 9 HyeS
NO
(prior to working at Shell or associated with a pan- 1--1
1--1
time job, or avocation)? If so, list
fo pUtc-^Ts " II, a r-e^J 4xo.Ur
--
rH-C f--I [_J Yti> 1___ 1 NU
------
VV-J
for t
wiui<u^<L ----
, --------------- ---------------------------------
f1 ( U A2VIA>WY~-
97a
RESULT OF REVIEW:
Recommendation:
REVIEWED V BY '
IF PLEURAL CHANGE
counseled OSHA Form 200:
Workers Compensation:
/,__ l)
/
EMPLOYEE REFERRED TO DR. (Please send copy of consultation when available)
COMMENTS:
NOTE; (check list of actions to be completed by the Company doctor and returned to registry in Houston, with one copy to be retained in employee's chart)
DATE
IF POSSIBLE FIBROSIS
DATE
TT *JoV i0 Oct %1
Patient counseled:
OSHA Form 200:
Worker's Compensation:
CONTEMPLATED FOLLOW-UP
Q PERIODIC EXAM
Q OTHER
INSTRUCTIONS: PART I - WHITE COPY - LOCATION MEDICAL DEPARTMENT
o vci i our rnov rnoonoatc ucnico ncDAnmcMT
ABS-055471
lam 032078
S-13200 (4/89) 006061
NAME OF EMW
-
PULMONARY REGISTRY
EMPLOYE^
LOCATION
-----
0j '
CONFIDENTIAL - MEDICAL
c
REASON FOR REVIEW 1. CHEST X-RAY REPORT INDICATING
/a)')pns<Jhlp pleural abnormality
(jj
p-A5
, i, Aj A-. c~ a yj'. ix
7. Has the employee had a job where it is possible, or ,--,
^
likely, that he has been exposed to some other agent
YES vj no
(K TyC-wuJ
known to cause a dust disease of the lung, (e.g.,
--1
Silica, etc.)? If so, list
y
h) Pncedhlp fihrnsis
2. PULMONARY FUNCTION TEST ABNORMALITY: a) FVn le<y; than 7S<& of predicted
8. PLEASE LIST JOB TITLES AND NO. OF YEARS IN THAT POSITION
11 l c\ 7 ~ - r rt-v-
h) Other
- Other reason lor review
M,
9 Is there any history of other respiratory illness that
could account for me X-ray abnormalities under consideration? If so, list
1 1 vcc ref 1___ I Ytil [__! NO
4 Time of
' service
i tf
-7 < >
S Has the employee worked In a facility that used asbestos so that It Is possible that a pleural plaque could be related to job exposure?
6. Has the employee worked at a job (e g., bricklayer, insulator, etc.) tor a sufficient time (usually at least
10 years) for it to be likely that asbestosis could
have developed?
i-t-v 1--1 jjj YES | | NO fU[\,re 1--1 no L_J Ytb 1__ 1NU
10. Is there a history of exposure to a pneumoconiosis
producing agent outside of employment at Shell (prior to working at Shell or associated with a parttime job, or avocation)? If so, list
`OCf
U- A?-n.-v
1(
Q-- jTdpJi
L)r -
.--.
c' YES NO -- 1--1
. J~r s r.i^o.l
RESULT OF REVIEW:
/ , , A1 i v'
*' 1 ' / i
\/* ; Oa\
Recommendation:
'V M r\f'y Vt ^ jV,
iji Hu j
<
^W U / -u.
fi 1 C/M&AjI
[j 1 ~LL^
Ai
REVIEWED k
by
jy / ____
\\ y/s(A/17
'Y//
f T ES O' i> 1--^ \ IF PLEURAL CHANGE \____ /
i \
/li_ _
Patient counseled:
----- r r.-o.. ; .'Ur.A^Aw-
'~7 /
A4AA , A<-7
OSHA Form 200:
u
Worker's Compensation:
EMPLOYEE REFERRED TO DR. (Please send copy of consultation when available)
DKS NAME
A(; v 1' `i -
/n
JK. /f
7--
.;
/V J;) " X'1-
NOTE: (check list of actions to be cdmpleted by the Company doctor and
returned to registry in Houston, with bne copy to be retained in employee's
chart)
`
IF POSSIBLE FIBROSIS
DATE
Patient counseled:
OSHA Form 200:
Worker's Compensation:
COMMENTS:
CONTEMPLATED FOLLOW-UP
Q PERIODIC EXAM
Q OTHER
INSTRUCTIONS: PART 1 - WHITE COPY - LOCATION MEDICAL DEPARTMENT o . vci i nw/ mov ,, rnQorvQATP MPmrAi ofpaotmfnt
ABS-055470
LAM 032077
S-12972 (11 -6)
ILO PULMONARY SURVEILLANCE WORKSHEET
EMPLOYEE NAME (First. Uiddl*. Last)
COMPANY i--r SHELL
1--l OIL COMPANY
|--| SHELL CHEM
1--1 COMPANY
r--) SHELL OEV LJ COMPANY
EMPLOYEE NUMBER
DATE OF X-RAY READING
10-25-89
OTHER
TYPE OF EXAMINATION
(--|
l--l (Spec/ty)--------- ----------------------------------------
0 ASBESTOS Q SILICA
OTHER
Q ,So,r,,
`------~
1 A. DATE OF X-RAY
18. FILM QUALITY
3 |u/n
2A. ANY PARENCHYMAL ABNORMALITIES CONSISTENT WITH PNEUMOCONIOSIS?
2B. SMALL OPACITIES
a. SHAPE/SIZE secondary
H Noi Grade 1
1C. IS FILM COMPLETELY NEGATIVE?
YES Proceed io
Section 5
NO [X] ?roc"tl 10 Section 2
YES I ( COMPLETE -----' 20 and 2C
NO fs3 LJa
PROCEED TO SECTION 3
c PROFUSION
%% % Vo V. 'A V, V* Vo V, Vj V*
2C. LARGE OPACITIES
Size
O A 8c
PROCEED TO SECTION 3
3A. ANY PLEURAL ABNORMALITIES CONSISTENT WITH PNEUMOCONIOSIS'7
YES
3B. PLEURAL THICKENING
a OiAPHRAGM (plaque)
3C. PLEURAL THICKENING
a CIRCUMSCRIBED ipiaqoe)
. Chest Wall
COMPLETE 38. 3C and 30
NO Q
PROCEEO TO SECTION 4
site
b COSTOPHRENIC ANGLE
Wsite
R LI
3D PLEURAL CALCIFICATION
SITE
IN PROFILE i WlOTH
n EXTENT FACE ON
i. EXTENT
o|y a
b 2
C 3
1 0 i VI 2 | 3 |
0A c 0 ' 12 3
[T
a oiaphRaGm 0 WALL C other sites
*1 1 1 U 3
_l*j X!1 H 3
SITE IN PROFILE
i WIDTH ii EXTENT FACE ON mi EXTENT
a OIAPHRAGM b wall c OTHER sites
EXTENT
0 1 | 2| 3
0 1 *1 3 0 1 Hl PPOCczD 1
SECTION 4
4A. ANY OTHER ABNORMALITIES'7 48 OTHER SYMBOLS (OBLIGATORY)
YES
COMPLETE 46 and 4C
NO I I |I
PROCEED to SECTION $
txcax | bu j ca j cnr j~co j cp | c*~| o< j gl | em | j tr | ru | no | <d | n ) hi | p< | | rp j ib |
Report items which may be
ol present clinical signifi cance m this section
Degenerative arthritis right Date Personal Phys.C.an notme^
ispecifyoai glenohumeral joint.
mOnT>
i
1 CLINICAL INTERPRETATION
2 B-READING COMMENTS
There are calcified pleural plaque ; on the right and sibly be a small noncalcified pleu. ral plaque high on
degenerative changes of the right < jlenohumeral joint
there may posthe left. Again
are noted.
PLEASE TYPE OR PRINT NAME OF PHYSICIAN
C qurp.-pr, /;V;.0. R. A. HUGHES. ivi.D.
.-q-v-P. 0.
iv-J
CITY'STrr- ;:PCOi-.
~
PHYSICIAN S SIGNATURE SlCNEO'
. .!C -21- Si
D-rEi c .r:
A?
/
r..c,7,,
ABb-0554 / 4.
LAM 032079