Document 8O46VjyD90JB3m0NJVwBrgGRm

4- - INTEROFFICE MEMORANDUM To From R. Fleming H. W. Smith Executive_________________________ (LocAtion, Organization, or Department) Safety - Trexlertown. Penna. (Location, Organization, or' (Department) cc: E. Blades T. Carey J. Novak M. Smith ^ M. Spurlock H. Watson Attached Is the National Institute of Occupational Health statement of medical screening to detect liver disease and/ or hepatic tumor which may occur after exposure to vinyl chlorides. R ..Lc~Pu,n APR 8 1374 V- " * Even though this statement Is a recommendation from NIOSH to OSHA, it should become our minimum general medical policy for our employees as well as those employees engaged under contractual agreements. This program should be put into effect In vinyl chloride act ivities until such time as additional information Is available and/or until modifications are indicated by qualified medical authority. The Corporate Safety Department Is currently preparing a similar document for TDA exposure. Any changes must be approved by the Corporate Safety Department. Should you concur with this program for vinyl chloride, all attend ing physicians for the chemical's group should be notified. t // b,s enclosure RECEIVED MAY 1U 1974 J. T. BARR (320) AP0000311f MEDICAL SURVEILLANCE - VINYL CHLORIDES THE FOLLOWING MEDICAL SURVEILLANCE PROGRAM RECOMMENDED BY THE NA TIONAL INSTITUTE OF OCCUPATIONAL SAFETY AND HEALTH WAS ISSUED ON MARCH 22, 1974. THIS DOCUMENT WILL APPLY TO ALL PERSONS INVOLVED IN VINYL CHLORIDE MONOMER PRODUCTION AND POLYMERIZATION INCLUDING THOSE CLERKS AND MANAGEMENT PERSONNEL INVOLVED INDIRECTLY WITH THESE OPERATIONS. THIS WILL NATURALLY INCLUDE THOSE PERSONS EN GAGED IN RESERACH AND DEVELOPMENT WORK. THE MEDICAL SURVEILLANCE PROGRAM IS RECOMMENDED TO BE APPLIED BOTH AS A PRE-EMPLOYMENT REQUIREMENT AND AS PART OF PERIODIC HEALTH FOL LOW UPS. 1. AT TIME OF INITIAL EMPLOYMENT OR UPON INSTITUTION OF SCREEN ING, A PHYSICAL EXAMINATION SHALL BE PFRFORMED WITH SPECIFIC ATTENTION TO DETECTING ENLARGEMENT OF LIVER OR SPLEEN BY AB DOMINAL PALPATION. 2. AT TIME OF INITIAL EMPLOYMENT OR UPON INSTITUTION OF SCREENING AND ANNUALLY THEREAFTER,' A MEDICAL HISTORY CHECK-LI ST SHALL BE COMPLETED BY THE EMPLOYEE. THIS LIST SHALL INCLUDE QUESTIONS CONCERNING: A. ALCOHOL INTAKE B. PAST HISTORY OF HEPATITIS C. PAST EXPOSURE TO HEPATOTOXIC AGENTS, INCLUDING DRUGS AND CHEMICALS D. PAST HISTORY OF BLOOD TRANSFUSIONS E. PAST HISTORY OF HOSPITALIZATIONS COMPLETED MEDICAL CHECK-LISTS SHALL BE REVIEWED BY A PHYSICIAN AND SHOULD BE ACTED UPON AS MEDICALLY INDICATED FOR EACH EMPLOYEE. AP00003112 MEDICAL SURVCILLANCE - VINYL QUPRISES ... Pago 2 3. AT TIME OF INITIAL EMPLOYMENT OR UPON INSTITUTION OF SCREENING, A SERUM SPECIMEN SHALL BE OBTAINED FOR SCREENING WITH RESPECT TO THE FOLLOWING FIVE (5) BIO-CHEMICAL DETERMINATIONS OF LIVER FUNCTION: A. TOTAL BILIRUBIN B. ALKALINE PHOSPHATASE C. SERUM GLUTAMIC OXALACETIC TRANSAMINASE CSGOT) D. SERUM GLUTAMIC PYRUVIC TRANSAMINASE (SGPT) E. GAMMA GLUTAMYL TRANSPEPTIDASE (GGTP) ADDITIONAL TESTS THAT MAY OPTIONALLY BE CONSIDERED FOR USE IN SCREENING INCLUDE LACTIC DEHYDROGENASE (LDH), SERUM PRO TEIN DETERMINATIONS, SERUM PROTEIN ELECTROPHORESIS, AND PLATELET COUNT. LABORATORY ANALYSES SHALL BE PERFORMED IN LABORATORIES ACCREDITED BY THE COLLEGE OF AMERICAN PATHOLO GISTS OR LICENSED IN ACCORDANCE WITH THE PROVISIONS OF THE CLINICAL LABORATORIES IMPROVEMENT ACT OF 1967. 4. IF RESULTS OF LABORATORY SCREENING ARE NORMAL, SCREENING SHALL BE REPEATED ON AN ANNUAL BASIS. IF THE PERSON BEING SCREENED HAS BEEN EMPLOYED DIRECTLY IN VINYL CHLORIDE MONOMER PRODUCTION OR POLYMERIZATION FOR TEN (10) YEARS OR LONGER, SCREENING SHALL BE REPEATED EVERY SIX (6) MONTHS. 5. IF ONE OR MORE LIVER FUNCTION TESTS ARE ABNORMAL, SERUM TESTING SHALL BE REPEATED AS SOON AS POSSIBLE, PREFERABLY WITHIN TWO (2) TO FOUR (4) WEEKS. IF NO ABNORMALITIES ARE PRESENT UPON RESCREEN ING, TESTING SHOULD BE REPEATED IN THREE (3) MONTHS. I AP00003113 MEDICAL SURVEILLANCE - VINYL CHLORIDCS * * Page 3 6. IF ABNORMALITIES PERSIST ON RESCREENING, THE EMPLOYEE SHALL l BE REMOVED FROM CONTACT WITH VINYL CHLORIDE MONOMER OPERATIONS AND AN INDIVIDUALIZED MEDICAL WORKUP SHALL BE INSTITUTED. SUG GESTED AS INITIAL STEPS IN MEDICAL WORKUP ARE A COMPLETE PHYSICAL EXAMINATION AND VARIOUS SPECIAL PROCEDURES SUCH AS HEPATITIS "B" ANTIGEN DETERMINATION AND LIVER SCREENING. IF LIVER FUNCTION ABNORMALITIES ARE DETERMINED TO BE UNRELATED TO LIVER DISEASE (E.G., ELEVATED ALKALINE PHOSPHATAES IN A YOUNG, PHYSICALLY ACTIVE MAN OR ELEVATED BILIRUBIN IN GILBERT'S SYNDROME) OR TO BE TRANSIENT (E.G., DUE TO RECENT HEPATITIS OR RECENT ALCOHOL INTAKE), THE EMPLOYEE MAY BE PERMITTED TO RETURN TO VINYL CHLORIDE RELATEO EMPLOYMENT, SUBJECT TO INDIVIDUAL MEDICAL EVALUATION. 7. IN VIEW OF THE PRELIMINARY RESULTS OF ANIMAL TOXICOLOGY STUDIES, IT IS RECOMMENDED THAT NO WOMAN WHO IS PREGNANT OR EXPECTS TO BE COME PREGNANT SHOULD BE EMPLOYED IN VINYL CHLORIDE MONOMER OPERA TIONS. NOTE I - AS VINYL CHLORIDE IS STILL UNDER INVESTIGATION BY NIOSH, IT IS ANTI CIPATED THAT THERE MAY BE CHANGES IN THE MEDICAL SURVEILLANCE PROGRAM. THIS DOCUMENT WILL BE UP GRADED AS THE NEED ARISES. NOTE 2 - THIS DOCUMENT STATES THE MINIMUM REQUIREMENTS. SHOULD ANY ATTENDING MEDICAL AUTHORITY DEEM THAT ADDITIONAL WORK MAY BE NECESSARY, THESE RECOMMENDATIONS WILL FORM THE BASE LINE EVALUATION. NOTE 3 - AS THESE RECOMMENDATIONS COULD APPLY TO ANY KNOWN OR SUSPECTED LIVER DISEASE OR HEPATIC TUMOR PRODUCING AGENT, THEY SHOULD NOT BE RESTRICTED TO VINYL CHLORIDES. NOTE 4 - ALL CHANGES TO THE RECOMMENDATIONS CONTAINED IN THIS DOCUMENT SHALL BE CLEARED THROUGH THE CORPORATE SAFETY DEPARTMENT. H. W. SMITH April 1974 AP00003114 & (1 S/ 'S', rc hr~A___ -v--' TEMPLE UNIVERSITY HEALTH SCIENCES CENTER PHILADELPHIA, PENNSYLVANIA 19140 OFFICE OF THE viCE PRESIDENT FOR HEALTH SCIENCES May 1, 19 74 msm MAY 31374 JL RIMING, )L E, Richard Fleming Group Vice President- Chemicals Air Products and Chemicals, Five Executive Mall Swedesford Road V7ayne, Pennsylvania 19087 Inc. Dear Dick: The trip to Pensacola was an informative one, both during my visit to the plant and my session with Dr. Beidelman. Dr. Eeidelman is both alert and sensitive, and the plant personnel are in very competent hands. I feel that any possible compli cation that might arise as a result of VCM exposure will be detected in conformity with sound principles of occupational and preventive medicine. Insofar as Paducah is concerned I am anxiously awaiting results of the rotesting of those employees with abnormal laboratory findings so that a meeting with Dr. Blalock a u be arranged. This certainly will be early in May, I hope, hhat protocols for those cases requiring continuing work-up < mi be developed. I anticipate it will mean another trip to Paducah, at which time I will plan to meet with Dr. Colburn again if you or Jack Kramer thinks it advisable. On my last visit to Paducah I did suggest the possibility of our getting together in the future if the circumstances warranted it. The matter of physicians for the Middlesex and Trexlertown facilities is very much on my mind now, and as I indicated to Marty my last irrevocalbe commitment to Temple ends Thursday, May 2, when the budget hearings for the University before the House and Senate Appropriations Committee in Harrisburg will be complete. In the same vein I will be meeting with Dr. Kuschner this weekend at which time 1 will do my very best to convince him to assume a consultant's role with APCI. For the record, last Saturday (April 27), Firestone Rubber Company, Pottstown, phoned Kuschner in an attempt to recruit him as a major consul tant for their corporation. Despite his refusal to them, I feel I can convince him to fill my shoes. I am well aware that you are a stickler for target dates and goal setting, so let me set Thursday, May 9, ac the vc-ry latest tor achieving the identi fication of physicians and, hopefully, the conversion of Dr. Kuschner. AP000031I5 Richard Fleming -2- May 1, 1974 In the normal course of events I would put the following items in an official report to you; however, I felt it best to incor porate my thoughts in this letter. My trip through the Pensa cola plant led to the following concerns s 1. The bagging operation was if anything no better or perhaps slightly worse than that in Calvert. I recognize that bagging is a dirty operation; however, this I believe makes superior vigilance in housekeeping even more imperative. Polymer dust had accumulated at all levels-floors, sills, tops of machinery, and at heights equal to the rafters. The higher levels of deposition are of special concern because, in contrast to spil lage, they reflect airborne particles which can remain suspended in the air for hours to days. 2. One of the reactors was being manually cleaned by a workman with gauntlet gloves which were partially rolled back; he was also wearing his own regular work shoes. Although he was wearing a mask, I could not really assess its level of pro tection and it was not on a supplied air line. 3. Except for this man I saw no one wearing any masks, even though all employees in the VC plant appeared to have free access to all parts of the plant as I did. The use of masks by visitors cr cccQS^LcnQl. cn u3 ^ r i -3 1 LllUUC.t_l4.C4. U L. V. . various steps in the manufacture of VC should, I believe, be likened to the wearing of hard hats in construction areas, a requirement for all. 4. The quality control and analytical labs in most industries somehow manage to escape scrutiny and therefore may be sites of unmonitored exposure. Hoods, portable or built-in, must be required because of the potential hazard from normal operation, to say nothing of accidental spillage or monomer escape. You will most likely be hearing from me the middle of next week. In the interim, all good wishes. Cordially., m Sin, M.D. Vice President Enclosure AP00003116