Document B81g4ap7EOQxrznj1oogXNr08

1 1 SUPERIOR COURT OF NEW JERSEY LAW DIVISION: MIDDLESEX COUNTY 2 DOCKET NO. L--060148--87 3 JOHN PETERSON and SHIRLEY : 4 MAE PETERSON, x : 5t Plaintiffs, : DEPOSITION UPON 6 : ORAL EXAMINATION OF: vs. : HENRYVELEZ 7 UNION CARBIDE CORPORATION, : 8: Defendants. : 9 10 11 TRANSCRIPT of the deposition notes of HENRY 12 VELEZ, witness called for oral examination in the 13 above-entitled action, said deposition being conducted 14 pursuant to the Rules Governing Civil Practice in the 15 Superior Court of New Jersey, by and before MAUREEN 16 RATTO, a Notary Public and Certified Shorthand Reporter 17 of the State of New Jersey, License No. XI01165, at the 18 offices of HENRY VELEZ, MD, 1903 Maple Avenue, Fair 19 Law, New Jersey, on October 24, 1989, commencing at 20 12:00 p.m. 21 22 23 ROBERT CIRILLO, INC. Certified Shorthand Reporters 24 5N-Regent Street-Suite 503 Livingston, New Jersey 07039 25 (201) 740-1331 RNW 2446 1 APPEARANCES: 2 LEVINSON, AXELROD, WHEATON & GRAYZEL, ESQS. 3 BY: RAE T. HOROWITZ, ESQ. Attorneys for the Plaintiff 4 PITNEY, HARDIN, KIPP & SZUCH, ESQS. 5 BY: MICHAEL K. TUZZIO, ESQ. Attorneys for the Defendant 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 2 RNW 2447 3 1 HENRY VELEZ, having been first 2 duly sworn according to law by the Officer, 3 testifies as follows: 4 5 DIRECT EXAMINATION BY MR. TUZZIOx 6 7 Q. Dr. Velez, my name is Michael Tuzzio 8 and I represent Union Carbide in this action instituted 9 by John Petersen and his wife. I'm here to take your 10 deposition and that's because we received a report from 11 the plaintiff's attorneys, a report drafted by you 12 dated August 15, 1989 and you've been named as 13 potential expert witness in this case. You've had your 14 deposition taken before, I assume? 15 A. I have. 16 Q. And very briefly, if you don't 17 understand a question that I ask please tell me and 18 I'll try and rephrase it in a way to help you 19 understand it. 20 You understand you're under oath and the court 21 reporter's purpose here and only thing I ask is that 22 you please keep your responses verbal and speak nice 23 and loud so that it makes it easier on her. 24 Let me start off, do you have your CV with 25 you? RNW 2448 VELEZ - Direct/Tuzzio 1 A. No, I don't. 4 2 Q. Do you have a CV? 3 A. I may have one. The problem is we ran out of 4 paper and we're waiting for a shipment of -- I may have 5 one though. 6 Q. When you get an up-to-date CV could 7 you please send it to the Levinson office and I'll ask 8 that you send us a copy of that, please? 9 A. Sure. 10 Q. Not having the benefit of your CV 11 I'll have to ask you some questions about your 12 background. When did you go to undergrad? 13 A. I went to Brooklyn College in New York City. 14 Q. And what year you get out? 15 A. 1973. 16 Q. With what degree? 17 A. None. None. 18 Q. You attended Brooklyn College? 19 A. That's correct. 20 Q. And then you went to another college? 21 A. No. I went to medical school after that. 22 Q. Where did you go to medical school? 23 A. New York Medical College in Valhalla, New York. 24 Q. And what year did you graduate from 25 there? RNW 2449 VELEZ - Direct/Tuzzio 5 1 A. 1976. 2 0. What did you do after graduation? 3 A. I spent a year at the Brookdale Hospital in 4 Brooklyn, New York and I completed one year internship 5 in medicine, internal medicine, to be specific. 6 Q. That would have taken you up to 1977? 7 A. That's correct. If you'd like I'll give you 8 the whole. 9 Q. Run through the whole thing instead 10 of me asking individual questions. That would be 11 great. 12 A. I from there I went to, from 1977 until 1979 I 13 went to the Mount Sinai Hospital, environmental 14 sciences lab under direction of Dr. Selikoff where I 15 spent two years in occupational and environmental 16 diseases. 17 Thereafter, I did another year of internal 18 medicine at the Veterans Hospital at Kingsbridge, 19 affiliate of Mount Sinai and completed my second year 20 of internal medicine. 21 Thereafter, I went to University Hospital at 22 Stoneybrook where I completed ~ from 1980 until 1982 23 where I completed two year fellowship in pulmonary 24 diseases. 25 In 1982 I came out to Paterson, New Jersey, RNW 2450 VELEZ - Direct/Tuzzio 6 1 joined a practice which did not work out and then from 2 October until December of 1982 I did a little bit of 3 private practice. In December of '82 I took a salaried 4 position at the Barnert Hospital in Paterson. And was 5 their director of ambulatory services to include 6 emergency room, clinics and occupational health center. 7 In April 1st, 1985 I entered private practice, 8 originally at another location, 25-15 Fair Lawn Avenue, 9 in Fair Lawn. And then we came here in May of 1987, at 10 this present address, which is 1903 Maple Avenue. 11 I've been in private practice since then. I 12 became board certified in internal medicine in 1983 and 13 board certified in pulmonary in 1988. 14 Q. When you worked with Dr. Selikoff, 15 what were your responsibilities? 16 A. I was a resident or fellow, depending on 17 whatever you wanted to call me and I was responsible 18 for participating in research projects, examining 19 people, participating in an occupational health clinic 20 that we had, reviewing literature, et cetera, et 21 cetera. They were actual classes in epidemiology and 22 occupational medicine. 23 Q. Was there a specific focus or field 24 of the research Dr. Selikoff was doing at that time? 25 A. Well, he had his fingers into numerous things. RNW 2451 VELEZ - Direct/Tuzzio 7 1 asbestos of course is what he is well known for. 2 Q. That is what I know him for and I 3 wanted to ask about your involvement with that and 4 whatever else he might have been doing at the time? 5 A. Right. Well, there were led studies going on 6 of burners. Those are people who use gas torches to 7 take apart steel structures and in this case it was the 8 the defunct Westside Highway and they suffered from led 9 toxicity. Policemen also had led exposure and couple 10 of others. 11 There were some projects with respect to 12 solvents and the big project with respect to 13 polychlorinated biphenols, which had accidently entered 14 the food chain in Michigan. 15 Q. What was your involvement with that 16 particular project, your own? 17 A. I was involved in the planning and execution of 18 the project. 19 Q. What would that mean, planning the 20 projects or -- 21 A. We would have meetings and we would discuss, 22 you know, how to approach a project of this type. 23 Q. How was that particular project 24 approached? 25 A. Well, it required travel to Michigan. It RNW 2452 VELEZ - Direct/Tuzzio 8 1 required sampling, so we had to come up with a sampling 2 method by which to randomly pick participants and then 3 notify these participants and then deal with the fact 4 that some would participate and some wouldn't. Then 5 there was the planning as to what should be tested for, 6 what should we do, what should we be looking at based 7 upon the known toxicities of the PCB's. 8 Q. What were the alleged injuries that 9 these people had suffered or what conditions? 10 A. Most of it really affected people, animals 11 through the food chain and it inadvertently got mixed 12 with cow feed instead of magnesium supplements which 13 should have been added to the cow feed. 14 So the cows were suffering from a lot of 15 spontaneous abortions. They were having 16 hyperkeratosis, which is an exaggerated growth of their 17 hooves, almost bizarre growth of the hooves. When they 18 did give birth it was a process that occurred 19 afterwards that the cow goes through and they weren't 20 fairing very well with that. So there was a lot of 21 maternal death. Failure to thrive and just plain 22 wasting away of these cattle, depending on how much of 23 the feed they ate. 24 The problem was that these were dairy cows and 25 therefore, the PBB's entered the diary chain there was RNW 2453 VELEZ - Direct/Tuzzio 9 1 food products, milk, cheeses, that sort of stuff. 2 Q. Did you uncover any problems that 3 humans were having as a result of this condition? 4 A. There was a lot of allegations. I know -- I'd 5 have to look at the final report, which was a monograph 6 on our findings. There was some liver toxicity found. 7 We performed fat biopsy and found samples of PBB or a stores of PBB in adipose tissue, fat tissues. But what 9 I remember was that we didn't find too much. 10 Q. These were people who would have li ingested these dairy products? 12 A. That's right, in the State of Michigan. 13 Q. What other projects did you work on 14 with Dr. Selikoff? 15 A. Well, Dr. Selikoff was constantly involved in 16 asbestos, so we worked with United Auto Workers, come 17 out to Paterson where he originally started. He was 18 part owner of a large building, which still stands. 19 And we would examine members of the United Auto Workers 20 sorry -- Insulators, they were Jersey-based. We'd 21 examine them. They'd be X-rayed, interpret the X-rays, 22 using the high or low criteria for interpretation. 23 Q. In your years with Dr. Selikoff, did 24 you do any studies with regard to workers or any 25 persons who were exposed to PBC? RNW 2454 VELEZ - Direct/Tuzzio 10 1 A. No. That had occurred before I got there. You 2 probably know that he -- the lab did do work -- was 3 involved to some extent with the Niagra angiosarcomas, 4 which were secondary to vinyl chloride. 5 Q. Was the angiosarcoma of the liver? 6 A. Yes. 7 Q. Did you do any work with Dr. Selikoff 8 with regard to exposures to vinyl chloride monomer? 9 A. No. All that work had actually been work 10 before I arrived. That work was done in just about two 11 years -- the publications were two years before I 12 arrived. 13 Q. There was no follow up during the 14 time that you were there? 15 A. No. Work had been done and that was that. 16 Q. When you said you went into practice 17 and then didn't work out, who did you go into practice 18 with? 19 A. I actually worked for a Doctor named Jack Sail 20 but I was actually working with someone you probably 21 know, Susan Daum. 22 Q. When did you work for Dr. Daum? 23 A. From July of 1982 until about early October of 24 1982. 25 Q. Had you been in practice with anyone i RNW 2455 VELEZ - Direct/Tuzzio 11 1 else other than Dr. Sail or Daum since you've gone into 2 private practice? 3 A. No. No one else. 4 Q. When you went into private practice 5 as you say, was that in '85? 6 A. I resigned and entered private practice 4-1-85. 7 Q. And that's -- you've been in private 8 practice on your own? 9 A. Yes. 10 Q. Do you have any associates now? 11 A. No, I don't. 12 0. Have you ever had any associates or 13 partners since you went into private practice in *85? 14 A. None. 15 Q. I asked you questions about whether 16 or not the Selikoff group was doing any work with PBC 17 or vinyl chloride monomer while you were there. And 18 you said no. That work had already been done. 19 Have you personally been involved in any cases 20 involving exposure to polyvinyl chloride, vinyl 21 chloride aonomer, at any time in your career? 22 A. I've seen a lot of cases from a factory nearby 23 called Pantasote. 24 Q. Can you spell that for us? 25 A. P-A-N-T-A-S-O-T-E, Pantasote, where resins were RNW 2456 VELEZ - Direct/Tuzzio 12 1 made, polyvinyl chloride, extruded, heated, et cetera, 2 et cetera. I've seen a number of persons out of that 3 factory for pulmonary and potential led complaints. I 4 examined them for purposes of disability, worker's 5 compensation? 6 Q. Do you have a file in which all those 7 workers are in one place coming out of that plant? 8 A. Yes, I do. 9 Q. Well, -- 10 A. Actually, I have a file for that particular law 11 group. 12 Q. Which attorneys are you working for 13 there? 14 A. The Wilentz people. 15 Q. These are all comp cases. Is that 16 right? 17 A. That's correct. 18 ( Whereupon, recess taken.) 19 Q. You were telling me about the 20 compensation case. 21 A. That's right. 22 Q. What are some of the findings that 23 you've been making with regard to these people in terms 24 of their physical condition? 25 A. The basic findings arerespiratoryproblems. RNW 2457 VELEZ - Direct/Tuzzio 13 1 which are chronic bronchitis, small airways disease, 2 emphysemia, and some have hypertension because there 3 was -- there is also led exposure at that plant. 4 Q. That was I guess going to be my next 5 question, other than exposure to the polyvinyl 6 chloride, what other types of things have they been 7 exposed to? 8 A. They had led. Specific ones are led. There 9 were other resins, different formulations, which I 10 couldn't help you with. 11 Q. Any asbestos over there? 12 A. Yes. There was some asbestos there. In the 13 plant, it's, you know, one of those situations where 14 there is a lot of asbestos insulation and people would 15 come in and do repairs and whatever, while people were 16 working. So there was bystander exposure and some of 17 the maintenance people actually -- I picked up a couple 18 of maintenance people who actually worked with asbestos 19 removal and replacement and they had -- I diagnosed 20 them as having asbestosis. 21 Q. Have you found any cancer over there? 22 A. I think there may have been one or two cancers, 23 lung. I'm not sure. I'd have to look. There were 24 quite a number of people that I examined. 25 Q. Any cancer of the larynx? RNW 2458 VELEZ - Direct/Tuzzio 14 1 A. None to my knowledge. 2 Q. Before you considered the case of 3 John Peterson had you ever diagnosed cancers of the 4 larynx as a result of exposure to polyvinyl chloride or 5 vinyl chloride monomer before? 6 A. No. I had never. 7 Q. In your practice, how would you 8 describe your practice; occupational medicine, internal 9 medicine? Is there a specialty you would prefer to 10 categorize your practice as? 11 A. It's a diversified practice. I see people for 12 routine internal medical problems. I do a lot of -- a 13 lot of legal work, mainly plaintiff, some defendant 14 work, for liability, actually. Pulmonary consultative 15 work. I have a hospital practice. I'm on staff at 16 several properties but I actually really work out of 17 only one. Valley Hospital in Ridgewood. I do a lot of 18 work for corporations. I do work for Portunoffs, 19 asbestos screening program. 20 Q. Consultant work? 21 A. Pee for service, usually per. In the case of 22 Fortunoff, they had asbestos problems. We did base 23 line. I see them once a year. And I basically set up 24 a program to conform to the CFR for -- current federal 25 regulations for asbestos screening program. I do a lot RNW 2459 VELEZ - Direct/Tuzzio 15 1 of work -- have been doing it for number of years for 2 Camdress McGee (ph) the big toxic waste people out of 3 Boston. I do all their New York and New Jersey 4 examinations. These people are exposed to everything. 5 A. They're young people, engineers. 6 Q. What would you -- I understand that 7 you're board certified in pulmonary and internal 8 medicine. Would you consider yourself a specialist in 9 any particular field? 10 A. Of pulmonary medicine? 11 Q. Yes. 12 A. Yes. I've lectured twice in the local area on 13 occupational lung diseases, with a flare towards 14 occupational asthma because I tend to see a lot of 15 that. 16 Q. That's the type of situation which 17 you have described in those Wilentz cases a lot of 18 chronic bronchitis? 19 A. Yeah. Ahum. 20 Q, Have you in your practice, whether it 21 be treating or consulting or consulting for the purpose 22 of litigation, been called upon to examine in the past 23 persons who presented with cancer of the larynx, before 24 John Peterson? 25 A. Yes. I've seen laryngeal cancer, sure. RNW 2460 VELEZ - Direct/Tuzzio 16 1 Q. In those situations have you been 2 asked to render any sort of opinion as to what might 3 have caused the laryngeal cancer? 4 A. Some, yes. And those were asbestos related. 5 Last one that I remember is a man who was coughing up 6 blood and I performed a bronchoscopy. 7 Q. What is that? 8 A. A flexible -- it's a fiber optic scope which I 9 passed through the nose into the trachea and into the 10 lungs and while I suspected it, as soon as I was in the 11 area of the larynx I saw a large bleeding tumor. So it 12 was clear that this was coming from the larynx and not 13 from the lung, and then I bowed out of the case and 14 ear, nose and throat people came in and did what they 15 had to do. But that was a laryngeal cancer. 16 In that case I just provided diagnostic 17 expertise and nothing else. 18 Q. Do you remember if that was an 19 exposure type case? 20 A* Ho. That was a straight forward call from a 21 colleague. I have so and so in the hospital coughing 22 up blood. As a pulmonologist, please evaluate. 23 Q. Some of your asbestos cases, do you 24 mind if I use that term, asbestos cases? 25 A. That's fine with me. RNW 2461 VELEZ - Direct/Tuzzio 17 1 Q. Some of your asbestos cases have been 2 laryngeal cancer cases, is that what you told me? 3 A. There have been a couple. That's correct. 4 Q. Have you come to conclusion in those 5 cases that the laryngeal cancer was as a result of 6 exposure to asbestos? 7 A. That's correct. 8 Q. Do you know what those cases -- do 9 you remember the names of those cases or at least the 10 attorneys with whom you worked on those cases? 11 A. I really don't. 12 Q. Did you write reports on those cases? 13 A. Yes. 14 Q. Did you testify in those cases? 15 A. To date, I have not. 16 Q. Are they active cases? 17 A. I would assume so. A lot of them -- those are 18 probably compensation cases and we don't know whether 19 they're settled or not. 20 Q. You don't track them that way? You 21 keep your reports and then someone might tell you the 22 case is settled or someone might give you an occasional 23 call and say this case is ongoing or you'll check in 24 every now and then? Is that the way it works? 25 A. No. Because the firms that I work for pay me RNW 2462 VELEZ - Direct/Tuzzio 18 1 in full for the report. So as far as I'm concerned 2 it's over, it's finished unless I hear from them. 3 I don't know what your experience is in 4 compensation but 99 out of 100 are settled one way or 5 the other and so I've never been called in to testify 6 on any of them. And I would figure with the normal 7 lead time the *87 cases are -- anything before '87 or 8 before has probably been settled, maybe some '88 stuff 9 too. 10 Q. When you came to your conclusions on 11 those other laryngeal cancer cases that the disability 12 condition was as a result of exposure to asbestos, did 13 you rely upon any learned treatises, text, prior 14 studies linking cancer of the larynx to asbestos 15 exposure? 16 A. Yes. There is a reasonable body of literature 17 out there, which links the two. 18 Q. Is it as common as other types of 19 cancer as a result of asbestos exposure? 20 A. NO. 21 Q. Mostly you're talking about a 22 mesothelioma situation, a lung situation, would that be 23 the most common asbestos-induced cancer? 24 A. Well, lung cancer first as you know. I'm not 25 really sure about the number of colon cancers, it's a RNW 2463 VELEZ - Direct/Tuzzio 19 1 common cancer. How much of it is actually attributible 2 to asbestos, I can't really say. I'd say it would be 3 after primary lung cancer and mesothelioma or maybe 4 equal to mesothelioma. 5 Q. Cancers of the larynx? 6 A. Yea. 7 Q. That is the question you're 8 answering, right? 9 A. Cancer of the larynx is not that common a 10 disease as is mesothelioma. Not that common a disease 11 whereas primary lung cancer is a very common disease. 12 Q. And are there other cancers which 13 would in frequency -- I hate to use these kinds of 14 terms in cancer but -- frequency rank behind cancers of 15 the larynx as a result of asbestos exposure, rarer 16 types of cancer as a result of asbestos exposure, for 17 lack of a better way to express it? 18 A. There have been reports about kidney, liver, 19 and I think even pancreas, some -- you know. 20 Q. When you say there is a reasonable 21 body of literature supporting relationship between 22 asbestos and larynx cancer can you cite for me now 23 some -- any of those articles? 24 A. Well, a lot of the work I remember of course 25 comes from Selikoff work because that's what I RNW 2464 VELEZ - Direct/Tuzzio 20 1 remember. A lot of work has been done on asbestos. 2 And there are numerous contributors. As I said 3 Selikoff stands out because of my association with him. 4 Q. Did you refer to any of those 5 articles concerning the link between asbestos and 6 cancer of the larynx incoming to your opinions in this 7 case? 8 A. Well, I refer to a body of literature and what, 9 in my opinion, which is based on what I've seen, what 10 I've learned in training and what I've read. 11 Q. But again, in this case did you have 12 any specific articles in mind when you came to your 13 opinions in this case or did you do any medical 14 literature research incoming to your opinions in this 15 case? 16 A. Peterson, regarding? 17 Q. Yes. 18 A. Regarding asbestos? 19 Q. Yes. 20 A. Ho. That would have been knowledge that I 21 have. 22 Q. In those othercancer ofthe larynx 23 cases that you've beeninvolved in andhavecategorized 24 those also as asbestos cases, was there exposure to 25 anything else other them asbestos? RNW 2465 VELEZ - Direct/Tuzzio 21 1 A. Nothing specific that I can think of. But a 2 lot of industrial exposures tend to be compounded, 3 compound ones, a lot of different agents or group of 4 agents, let's say. 5 Q. You can't identify all the agents or 6 irritants but the industrial setting creates that, is 7 that what you're telling me? a A. That's correct. 9 Q. But asbestos was something that was 10 specifically identified in those other larynx cancer n cases? 12 A. That's correct. 13 Q. You said that you do spend -- and I 14 don't want to miscategorizes -- but you said that I 15 think a substantial amount of your time spent with 16 litigation now, I don't know if those were your terms. 17 If not don't answer the question. Let me ask you a 18 different way. 19 How much time do you spend in your practice 20 with regard to litigation? 21 A. With respect to work which had some sort of 22 legal application to it or other -- 23 Q. Either comp or liability, is that 24 what you're talking about? 25 A. That's correct. I can only break it down into RNW 2466 VELEZ - Direct/Tuzzio 22 1 tine or actually, what percentage of my total income. 2 Q. I'm not going to ask you for your 3 total income. Can you break it down into a percentage? 4 A. That's what I was thinking about. Probably 20 5 to 25 percent, probably more towards the 25 percent. 6 Q. Of the litigation type cases either 7 comp or liability, can you categorize how much of your 8 time you spend on behalf of plaintiffs/petitioners as 9 opposed to defendants/respondents? 10 A. Probably 98 percent of my time. 11 Q. For the plaintiff's and petitioners? 12 A. Let's say 95 percent. 13 MR. TUZZIOt Can we have this 14 marked, notice to take deposition and produce 15 documents and we'll mark it as 0-1. 16 (Notice to take deposition and 17 document request is received and marked D-l 18 for identification.) 19 Q. We've just had this marked as D-l, 20 notice to take deposition and produce documents. I saw 21 another copy on your desk when I walked in here before. 22 Is that it? Why don't you work off that copy? When 23 did you first see that for the first time? 24 A. It's dated October 16th by the Levinson firm 25 sent to me. I saw it last weekend. RNW 2467 VELEZ - Direct/Tuzzio 23 1 Q. Well, let me go through the specific 2 requests. Deposition notice includes several requests 3 for documents to be produced here. And number one and 4 records of all communications between him, meaning Dr. 5 Velez and attorneys for the plaintiffs including 6 correspondence, memoranda, notes regarding telephone 7 conversations and other oral conversations and the 8 like. Did you produce documents here today which would 9 be in response to that request? 10 A. That's correct. I have. 11 Q. Can I see what you have? 12 MR. TUZZIO: Did you take a 13 look at them already? 14 MS. HOROWITZ: Yes. 15 ( Whereupon, discussion is 16 held off the record.) 17 Q. One of the things you produced is 18 this letter of August 8, 1989 from Mr. Levinson to you 19 with attachments as set forth in the letter 20 occupational medical history from 1967, et cetera, 21 occupational medical history from June 12, 1975 and 22 1978, personal history and medical history and X-ray 23 report dated April 8, 1982 I have from Mount Sinai. 24 And then again, letter speaks for itself. 25 Was this the first written contact you had RNW 2468 VELEZ - Direct/Tuzzio 24 1 with the Levinson office with regard to this case? You 2 can take a look at it. It looks to be the type of 3 thing they might have sent you first, to get you 4 rolling on this case. I don't know if that's -- 5 A. That would be correct. 6 MR. TUZZIOs Can I have this 7 marked, please, as D-2? 8 (Letter of 8-8-89 is received 9 and marked D-2 for identification.) 10 MR. TUZZIOs We'll mark the 11 letter and attachments as opposed to each 12 individual one. 13 MS. HOROWITZ: All right. 14 MR. TUZZIOs D-2 is the August 15 8, 1989 letter from Alfred A. Levinson to Dr. 16 Velez, with attachments as I just described. 17 Q. The personnel personal history 18 attached to this letter, do you know who took this 19 personal history? 20 A. Wo. I don't. 21 Q. You did not, obviously? 22 A. That's correct. 23 Q. The item four in Mr. Levinson's 24 August 8 letter to you makes reference to an X-ray 25 report dated April 8, 1985, in connection with this RNW 2469 VELEZ - Direct/Tuzzio 25 1 Mount Sinai Hospital admission showing a chest problem 2 and then say (rule out asbestosis). What did you 3 understand that to mean? Take a look at it. 4 A. Is the question really what does that mean to 5 me? 6 Q. What does that mean to you? We don't 7 know what Mr. Levinson meant because he's not here. I 8 guess a better way and there might be a third or fourth 9 answer to this but I want to know if you read it as a 10 request to you to rule out asbestosis in this case or 11 that it was -- whether you read it is a reference back 12 to what Mount Sinai did ruling out asbestosis? 13 A. I just look at it be aware there is a report in 14 there where the issue of asbestos was entertained. 15 Q. And ruled out? And ruled out? 16 A. No. Ruled out in medical terms is not the past 17 tense. It's, there are abnormalities, so then there is 18 a differential diagnosis. So rule out means you still 19 have to diagnose it. 20 Q* Did you understand that and again we 21 don't know what Mr. Levinson meant. But when you under 22 took to do your examination and consider this case, did 23 you understand you were being asked to rule out 24 asbestosis in this case? 25 A. I see people for pulmonary problems, obviously. RNW 2470 VELEZ - Direct/Tuzzio 26 1 We do X-rays and pulmonary function tests. Now, he had 2 a grossly positive X-ray, so whether that was there or 3 not, I'm still making independent judgements, opinions, 4 diagnosis, based on the information that I put together 5 here in the office. 6 Q. Which was the grossly positive X-ray 7 that he had and what was it grossly positive for? 8 A. It was grossly positive for pulmonary and 9 pleural asbestosis. That's in my report. 10 Q. I understand. Was that X-ray you 11 took here or was that the Mount Sinai X-ray you were 12 talking about? 13 A. My X-ray. I always quote from my X-ray. 14 Q. Can I see that? Mr. Levinson goes on 15 on the next paragraph to say that the personal history 16 shows no connection with asbestos even in his military 17 service and his only exposure was polyvinyl chloride 18 and the monomer vinyl chloride. 19 When you looked at the personal history that 20 was sent to you by the Levinson firm, did you confirm 21 that at least in that personal history there was no 22 mention of asbestos? If you want to look at it now you 23 can. I haven't seen it yet. 24 A. There was no mention of asbestos. I remember 25 that. RNW 2471 VELEZ - Direct/Tuzzio 27 1 Q. Your report does talk about asbestos 2 exposure? 3 A. That's correct. 4 Q. Did you take your own personal 5 history from Mr. Petersen? 6 A. That's correct. 7 Q. And in that personal history I assume 8 that at least some exposure to asbestoswas revealed? 9 A. That's correct. 10 Q. Do you have copies of your notes? 11 Would that be part of this file here from the history 12 that you took of Mr. Petersen? 13 A. What I probably did in this case,normally we 14 take notes. I use the supplied history as a guide and 15 then I inquired further. So anything that is here in 16 the occupational history set forth in the report is a 17 combination of what was provided and what we were able 18 to take from Mr. Petersen. 19 Q. Do you use a checklist type form that 20 is similar to what Susan Daum uses for -- to inquire 21 about potential exposures? 22 Km For the compensation cases, for one law firm we 23 do. For the cases which I do for the Levinson firm and 24 most of the -- actually all the occupational histories 25 are initially taken by the nurse who works for me and RNW 2472 VELEZ - Direct/Tuzzio 28 1 we follow a chronological order. When they graduated 2 high school, and then all the way through and try our 3 best not to have any gaps. 4 Q. What was the evidence that you 5 obtained in this from Mr. Petersen that there was at 6 least some asbestos exposure in his background? If you 7 want to refer to your report, you may. 8 A. On page two of the report, in the continuation 9 of the occupational history, about half way down I 10 state -- 11 Q. Brake lining situations? 12 A. Of importance is that when he first arrived at 13 ATC and for the first five years or so and it goes on 14 and on, that there was asbestos. There was exposure to 15 asbestos containing brake pads. 16 Q. Okay. 17 A. And thereafter he did some boiler maintenance 18 which required the use of the application of asbestos 19 materials. 20 Q. When you met with Mr. Petersen and 21 when your nurse gave you the history that she took and 22 did you have any conversations with him about his 23 potential or his past asbestos exposure, you 24 personally? 25 A. Yeah. It's all there. RNW 2473 VELEZ - Direct/Tuzzio 1 Q. No. I guess maybe you don't 29 2 understand the question. You said your nurse took a 3 history from him? 4 A. No. In this case since I already had the 5 initial history and I had the X-ray in front of me, I 6 went in and took the history of the rest. 7 Q. You had the history from the Levinson 8 office. I'm just trying to get sequence of events. 9 You took an X-ray of him. Then seeing the X-ray 10 something led you to have a further conversation with 11 Mr. Petersen, is that fair to say, something you saw in 12 the X-ray? 13 A. Yes. X-ray was characteristic of asbestos 14 exposure. 15 Q. So at that time you thought prudent 16 to follow up on the history? 17 A. Well, the question there is to find out where 18 he got it. 19 Q. Do you remember how that conversation 20 transpired? Took place? What he said? How you were 21 able to get out of him what obviously the Levinson firm 22 didn't get out of him? 23 A. You know, part of let's say knowing this 24 business if you want to call it that you have to know 25 where exposures come from. And that's what makes the RNW 2474 VELEZ - Direct/Tuzzio 30 1 difference between doctor trained in occupational 2 medicine is awareness of exposures after seeing so many 3 asbestos cases, you pretty much know where the 4 exposures are and so just go through a checklist and 5 say did you work with, did you work with, did you work 6 with and so forth and so forth and try to jog the 7 memory of the person. 8 Q. It's fair to say his X-ray was 9 consistent or at least -- was indicated prior asbestos 10 exposure based upon your experience in occupational 11 medicine? 12 A. The work is characteristic. 13 ( Whereupon, discussion is 14 held off the record.) 15 Q. Based on your experience would it be 16 fair to say that if you had no other history of 17 exposure other than the asbestos exposure which you are 18 able to draw out of this picture the Frake lining 19 exposure and the I think there were some sort of 20 insulation type exposure, that his X-rays would have 21 been consistent with those exposures absent anything 22 else? You can strike the question then. 23 The history that he gave you of asbestos 24 exposure, was consistent with the X-ray findings that 25 you made? RNW 2475 VELEZ - Direct/Tuzzio 1 A. That's correct. 31 2 Q. And if there had been no other 3 history of any other type of exposure, you would have 4 been satisfied based on those X-rays and based on the 5 history that he gave you of asbestos exposure that you 6 had at least found some causal connection? 7 A. That's correct. 8 Q. If you can't answer this, let me 9 know. Did he appear suprised when you -- I assume you 10 informed him of your finding you thought he had 11 asbestos related disease? Can you explain to me what 12 his reaction was? 13 A. I really don't remember. 14 Q. Did you discuss that issue with the 15 Levinson office before you committed it to writing? 16 A. At the time that I see the patient the report 17 is dictated. And then I see it again when it's -- when 18 the initial typing is done for proofing. I did contact 19 the Levinson firm after seeing Mr. Petersen and stated 20 to them that there was an exposure to asbestos and that 21 there were objective findings which would support that 22 diagnosis. 23 Q. Who did you speak to at the Levinson 24 office about that? 25 A. Mr. Levinson. RNW 2476 VELEZ - Direct/Tuzzio 32 1 Q. Do you remember what he told you when 2 you told him that? 3 A. He was suprised. 4 Q. The -- in the cover letter it talks 5 about occupational medical history. Are these the -- 6 where would that be? I can't find that done in 7 narrative form in the way the personal history is done. 8 And again, we're referring to D-2. 9 A. It starts with P here. 10 Q. Did you rely upon the personal 11 history and occupational medical history that was 12 forwarded to you by the Levinson office in coming to 13 your opinions in this case? 14 A. Yes and no. Everyone who comes in here gets a 15 comprehensive history and physical examination, which 16 is independent of anything that maybe supplied. Some 17 of the things that I found probably all the things are 18 fairly well corroborated with that history that's 19 documented there by the Levinson firm. 20 But again, I would like to state that the -- 21 it's my policy to perform an independent history. As a 22 matter of fact we even give them a form which we have 23 here and they fill out. 24 Q. That was the type of form that I had 25 asked you about before, similar to what Dr. Daum uses? RNW 2477 VELEZ - Direct/Tuzzio 33 1 A. Not for exposures. This is a standard personal 2 history, family history, symptoms that they maybe 3 having, social -- how much they smoked, allergies, 4 immunizations, et cetera. 5 Q. I'll ask you about that in a second. 6 We're still really talking about the first request to 7 produce. 8 What do you remember other than the asbestos 9 situation, what do you remember, if anything, finding 10 out from the patient that was divergent or contrary to 11 the personal history and medical history and 12 occupational medical history given to you by the 13 Levinson firm? 14 A. The only difference I think was the fact that I 15 was able to document an asbestos exposure, whereas they 16 were not able to. 17 Q. What else did you produce here today 18 in response to our request number one? I think you 19 gave me that file and I gave it back to you to refer 20 to. What is that file? 21 A. This is my office medical record. It includes 22 the history and all -- basically everything that 23 pertains to Mr. Petersen that was generated in this 24 office or came through this office. 25 MR. TUZZIOi Okay. Can I mark RNW 2478 VELEZ - Direct/Tuzzio 34 1 the outside of the folder D-3 and then the 2 individual items D-3a, b. 3 THE WITNESS: That's fine with 4 me. 5 MR. TUZZIOt The folder itself 6 and it was just described by the Doctor, we'll 7 mark as D-3 and then I'll open up the folder 8 and look at the things inside it and if 9 necessary, we'll mark the individuals items 10 D-3a, b or c. 11 (Vanilla folder is received 12 and marked D-3 for identification.) 13 Q. Just so I know what's part of what, 14 was the August 8, 1989 letter from Mr. Levinson and the 15 attachments which was marked as D-2, was that part of 16 your folder also? 17 A. That's correct. 18 Q. Okay. I'm looking at the check lists 19 format we've been talking about, which is the family 20 and personal health history. Do you remember who in 21 your office took that? Would the handwriting help you? 22 A. No. They fill it out themselves. 23 Q. This was sent to him in advance? 24 A. Is it folded three ways? 25 Q. Yes. It looks like it was in an RNW 2479 VELEZ - Direct/Tuzzio 1 envelope? 35 2 A. It'8 sent to him in advance. He comes back 3 with it and it's edited by me. 4 Q. Did you rely on the information that 5 was in here incoming to your conclusions in this case? 6 A. That's correct. 7 MR. TUZZIO: Would you mark 8 this as D-3a? 9 (Medical history is received 10 and marked D-3a for identification.) 11 Q. Obviously every -- and this is very 12 comprehensive and every item in here is not of 13 significance to your opinion in this case. But can you 14 tell me which items were of significance, even to a 15 minimal degree, incoming to your conclusions or 16 opinions in this case? 17 A. The smoking history. 18 Q. What was the smoking history? 19 A. I have here that he started smoking at about 20 age 16 or 17 he smoked less than one pack per day. He 21 did inhale. And he discontinued the use of all tobacco 22 products at age 38. 23 Q. What is or what was significant about 24 his smoking history to you? 25 A. One would characterize it as a mild, mild or RNW 2480 VELEZ - Direct/Tuzzio 36 1 moderate or significant, you know, severe smoking 2 history and characterize it as mild. 3 Q. And what does that characterization 4 of mild mean to you or how does it impact on your 5 opinion in this case? 6 A. Well, there is a definite relationship between 7 smoking and laryngeal cancer. 8 Q. Are you aware of any statistics or 9 ratios, rates, percentages, with regard to that 10 relationship? 11 A. No. Not really. 12 Q. Have you ever diagnosed anyone as 13 having -- diagnosed anyone with laryngeal cancer as a 14 as a result of cigarette smoking without any known 15 exposure to any toxins, irritants, agents? 16 A. That last patient that I broncoscoped -- 17 because I take occupational history on my hospital 18 patients also. And I forgot what exactly he did. But 19 the only risk factor in his case was smoking. 20 Q. If Mr. Petersen had not had a history 21 of any occupational exposure, but presented with that 22 history of smoking and the same condition, laryngeal 23 cancer, would you have been able to find to a 24 reasonable degree of medical probability there was a 25 connection between the laryngeal cancer and the RNW 2481 VELEZ - Direct/Tuzzio 37 1 smoking? 2 A. That would have been -- the answer is no. That 3 would be a tough one because the relative risk of lung 4 cancers goes down very rapidly after the cessation of 5 smoking and it's my understanding that the same occurs 6 with laryngeal cancer. That Mr. Petersen had a 21 year 7 hiatus, where he did not smoke. The -- some people say 8 two years. This is data for lung cancer and some take 9 it out to five years. But most people agree that once 10 you've stopped smoking for five years the relative risk 11 of developing a primary lung carcinoma is about that of 12 the general population, or those people who do not 13 smoke or who have never smoked, let me put it that way. 14 Q. Absent the history of exposure as 15 presented by Mr. Petersen, would you have been able to 16 even characterize the smoking as a possible cause of 17 his laryngeal cancer? 18 A. Just looking at smoking, previous smoking? 19 Q. Yes. 20 A* In all fairness one would have to say it's 21 possible, again, within the framework that I presented 22 earlier. 23 Q. Are you able to say to a reasonable 24 degree of medical probability that the smoking in and 25 of itself was not the cause of his laryngeal cancer? RNW 2482 VELEZ - Direct/Tuzzio 38 1 A. Based on the information given, it would be my, 2 in this case, this particular case, Mr. Petersen, it 3 would be my medical opinion that the smoking did not 4 play a material -- did not play a material -- was not 5 materially associated with his subsequent development 6 of the laryngeal cancer. 7 Q. Do you have an opinion as to whether 8 it played any role in this case, in his development of 9 laryngeal cancer? 10 A. Based on the information that I've set forth 11 here, and knowing that there is a -- that the risk goes 12 to that of the general population who doesn't smoke, 13 then one would have to say that if he developed 14 laryngeal cancer, that he's basically at the same risk 15 as the general population. One could theoretically say 16 he used to smoke and et cetera, et cetera. But I think 17 the reference point to the general population, where 18 then say it's just laryngeal cancer, from other sources 19 that we cannot identify. 20 Q. When you identify I think you used 21 the time frame of five years after one stopped smoking, 22 do you know the basis for that five years? Let me 23 explain the question. 24 Are you saying if a person is going to get 25 cancer after he stops smoking he'll get it in that five RNW 2483 VELEZ - Direct/Tuzzio 39 1 years or are you saying that in that five year period 2 there is some sort of healing process that makes one 3 less likely to get cancer? 4 A. Both. 5 Q. I had a feeling that was going to be 6 your answer. Can you explain that a little? 7 A. Well, the chronic irritation or the chronic 8 presentation of a carcinogen to susceptible tissue 9 occurs while the substance is present. 10 If you withdraw the substance, okay, these 11 tissues that are affected are epithelial tissues. In 12 other words, tissues that -- at the surface constantly 13 regenerate, as matter of fact. Therefore, anything 14 which may have been going on would revert back to 15 normal tissue. 16 There is, of course, a point of no return. And 17 we all know of this. I stopped smoking and I still got 18 my cancer a year later. That's because that cancer had 19 really started maybe two years before that or even 20 three years before that. Dependent on the cancer, and 21 the type of tissue and what we call doubling time, one 22 cell becomes two abnormal cells, and two abnormal 23 becomes four and eight and so forth and so forth. 24 It takes about, in the lung, more specifically, 25 I think it takes somewhere between nine and ten RNW 2484 VELEZ - Direct/Tuzzio 40 1 doublings before you even see a mass. 2 So if you figure the average doubling time is 3 less say three to four months, you're looking at three 4 to four years of a process already going on, even if 5 you remove the causative agent. 6 Again, in all of our -- in all of our clinical 7 experience things which tend to go on for a long time, 8 patient comes in with sort of vague symptoms. You 9 can't find anything and continue to go on without 10 declaring themselves are usually have no -- will not 11 declare themselves. If that's going to happen it's 12 going to happen, basically. 13 Q. Is it fair to say that the lapse of 14 time from when he stops smokinguntil the onset of his 15 cancer is a factor in your conclusion that the smoking 16 had little or nothing to do with his larynx cancer in 17 this case? 18 A. That's correct. 19 Q. Because when you talk about that 20 point of no return, once someone reaches that point of 21 no returns, he or she will get that cancer within five 22 years, is that what the literature says? 23 A. No. What I'm saying is that at the time that 24 they stop smoking the, whatever, one cell was already 25 underway. It might have been two cells. But there was RNW 2485 VELEZ - Direct/Tuzzio 41 1 already malignancy or a premalignant condition. We 2 know that there are tumors which have a potential for 3 malignant transformation. 4 So while they may be benign at one point, their 5 continued existence is toward malignancy. So whatever 6 that biological process is, is independent of the time 7 that you start smoking or not. It's either there or 8 not there. If you stop smoking, and it's not there, 9 then it's just going to get better. Nothing will 10 happen. But if the process is already underway and you 11 stop smoking it doesn't matter. Because a year later, 12 two years later, three years later, you're going to see 13 this. It will basically rear its ugly head. 14 ( Whereupon, discussion is 15 held off the record.) 16 Q. What else in the personal history, 17 you just talked about smoking, was significant to you 18 in coming to your opinion in this case? The personal 19 history you took on that chart that you took, which we 20 marked as D-3a? 21 A. Alcohol intake is minimal. He stated that he 22 drinks, either two cans or two bottles of beer per 23 week. And that he drinks hard liquor only socially. 24 So one would say it's a minimal alcohol intake. 25 Q. What role or significance does RNW 2486 VELEZ - Direct/Tuzzio 42 1 alcohol have in cases such as Mr. Petersen or other 2 occupational exposure/cancer type cases? 3 A. That relationship is sort of interdefined very 4 heavily with smoking. The question is whether alcohol 5 by itself is carcinogenic or is it that people when 6 they drink they smoke more. 7 A basic state of the art synopsis of it; I 8 don't think you find people who drink heavily and don't 9 smoke and who get laryngeal cancer. In my recollection 10 of the literature is that the two are very closely 11 intertwined. And therefore, the questionable etiology 12 of alcohol by itself is not that clear. 13 Q. Is it something that -- is it a 14 factor that a lot of these people who presented with 15 occupational type diseases just more so than not happen 16 to be people who do like to have a drink more than the 17 average person? 18 A. I don't know. That would be sort of a bias. 19 But that's probably more subject to our own personal 20 biases. Do I have information that says blue color 21 workers drink more than white color workers? I have no 22 information. I think that it would be just -- ay 23 anecdotal response would be just as it is yours or 24 anyone else's in this room. 25 Q. But alcohol in and of itself hasn't RNW 2487 VELEZ - Direct/Tuzzio 43 1 been found to cause the types of cancers that these 2 people with occupational exposure are presenting or has 3 it? I don't know. 4 A. Well, -- 5 Q. You sention alcohol a significant 6 factor. And I want to know why it's even considered in 7 a case like this? 8 A. Well, if you look at, pick up a standard text 9 book which tends to be conservative by nature, it's a 10 text book, you'll see alcohol and drinking as the basic 11 etiologies, maybe by now asbestos has made it in, basic 12 etiologies of laryngeal cancer. And then they'll go on 13 to say the same thing I've already told you, that 14 they're closely intertwined, bla,bla,bla and it's hard 15 to pick it apart. 16 Q. Closely intertwined with smoking? 17 A. Right. 18 Q. What else in that chart was 19 significant to you in coming to your conclusions in 20 this case? 21 A. That's basically it. 22 Q. Also part of your file which is 23 marked as D-3 is a copy of your report. I'll probably 24 mark another copy of that so I won't mark that now. 25 This is the -- I have a yellow form which is your RNW 2488 VELEZ - Direct/Tuzzio 44 1 physical examination. Then there are right after that 2 come the results of the pulmonary function testing. Is 3 that what that is? 4 A. That's correct. 5 Q. What came first your physical 6 examination or the pulmonary function testing? 7 A. Usually I have everything in front of me. X-ray 8 and pulmonary function test. 9 Q. Before you see him? 10 A. That's correct. 11 Q. Okay. So that just to keep things in 12 proper sequence, you and I should probably talk about 13 the pulmonary functioning testing before we get to the 14 examination. Who did the pulmonary function testing? 15 A. Does that -- probably says KH somewhere. No. 16 This is more sophisticatedpulmonaryfunction testing 17 done by a colleague. 18 Q. Why don't you -- can you separate all 19 the documents which pertain to, specifically to the 20 pulmonary function testing and I'll try and keep those 21 all in one place and as one exhibit. 22 A. Spirometry, pulmonary function testing was done 23 in this office and that was done by the nurse, who is 24 certified to administer a pulmonary function testing. 25 She's got her certificate hanging up in there. The RNW 2489 VELEZ - Direct/Tuzzio 45 1 spirometry is done in this office. They both have my 2 name on it. 3 MR. TUZZIO: Why don't you 4 mark these as D-3b-i and ii. 5 (Pulmonary testing reports are 6 received and marked D-3bi and D-3bii for 7 identification.) 8 Q. Can you explain a little bit about 9 what spirometry testing is? 10 A. Simple spirometry is what I perform here. It 11 measures the force vital capacity which is the major 12 portion of the total lung capacity. It does not 13 measure the residual volume, that amount of air which 14 remains in the lung no matter how hard you push, 15 squeeze, et cetera, et cetera. Combination of residual 16 volume and forced vital capacity gives you total lung 17 capacity. 18 Decreases in the force vital capacity is 19 suggestive of restrictive lung disease. The equipment 20 also then looks at that total volume force vital 21 capacity and measures how much of it is exhaled -- how 22 much of it has been exhaled at one half second, one 23 second and three seconds. 24 It takes that information and gives you a flow 25 volume curve. In other words, flow plotted against RNW 2490 VELEZ - Direct/Tuzzio 46 1 volume. And there are basically time honored standards 2 as to what would be considered obstructed or as the 3 name applies, restricts to air flow once it's in the 4 lung and to what is not obstructed. And in addition, 5 there is measurement of small airways parameters. 6 Obstructive component is divided into large 7 airways and small airways. The FEV1/FVC is 8 generally -- well, it is the time honored standard for 9 obstruction in general. And generally refers more to 10 the mechanical condition of the large airways. Those 11 are airways greater than two millimeters in diameter. 12 Airways less than two millimeters in diameter, 13 arbitrary by convention, whatever you want to -- 14 however you want to say it, are considered the small 15 airways. 16 Therefore, the parameters beginning with the 17 FEF 25-75 percent and going down, for the most part 18 reflect small airways function. 19 These are the obstruction of the small airways. 20 These are the parameters which we measure with simple 21 spirometry in the office. 22 Q. What were the results of the 23 spirometry in this case? 24 A. The spirometry revealed obstruction of the 25 small and large airways. And they find in RNW 2491 VELEZ - Direct/Tuzzio 47 1 characteristic of chronic obstructive pulmonay disease. 2 Q. The obstruction in both the small and 3 large airways, is that something that's consistent with 4 cancers of the larynx or his larynx condition in and of 5 itself? 6 A. No. Persons who have significant obstruction 7 of the upper airway have difficulty -- I have to get 8 this right. On inspiration the pressure goes negative. 9 So tissue pressure becomes positive. So these people 10 have difficulty on inspiration. They have a 11 characteristic curve. 12 Q. We say these people, who do you mean? 13 A. People who have significant obstruction of the 14 upper airways. But we're talking about the 15 intrathoracic portion. That portion -- actually, the 16 larynx is out of the thorax. On expiration -- right -- 17 on expiration, due to positive pressure coming out, 18 they are going to have -- their curves are going to 19 flatten out. They're going to get to a certain point 20 and then their flow is going to be limited by the 21 physical characteristics of this tumor or whatever it 22 may be that's obstructing the air flow out. 23 He had no problems producing a normal peek 24 expiratory flow. He has no limitation. None of these 25 findings or -- there is no evidence that there is RNW 2492 VELEZ - Direct/Tuzzio 48 1 larynx, but he doesn't have a tumor also, is playing 2 any part in any of these findings here. 3 Q. Would you expect, if all pulmonary 4 factors were equal, that someone with his larynx 5 condition would have a different spirometry finding 6 than someone without his larynx condition? 7 A. No. Because the -- when you have upper airway 8 obstruction, whether it be within the throax or out of 9 the thorax, you're talking about people with 10 significant encroachment on the lumins of the trachea. 11 I'm talking about really big, maybe ten percent 12 of the area, 20 percent is left. And that's why these 13 people have these problems. Kids who get streptococcal 14 sore throats and epiglottis, so they wind up that way 15 because the epiglottal is so swollen that it just, in 16 essence, chokes them. But people with laryngeal 17 tumors, they're diagnosed before they get to that 18 position. So it can happen. But generally doesn't 19 happen. 20 Q. Is it fair to say you concluded in 21 this case his spirometry findings were pulmonary as 22 opposed to larynx related? 23 A. That's correct. 24 Q. What was this significance of those 25 findings to you as practitioner? RNW 2493 VELEZ - Direct/Tuzzio 1 A. It shows obstruction, obstruction of the 49 2 airways and as I stated before, consistent with 3 obstructive pulmonay disease. 4 Q. Did these findings in and of 5 themselves at least lead you to look for things such 6 asbestos as a possible cause of these obstruction? 7 A. Well, asbestos really characteristically is a 8 restrictive disease. The small airway abnormality seen 9 in asbestos tend to be decreased or be super normal. 10 So there is limited -- by themselves, their 11 diagnostic -- diagnostically it's limited. You have to 12 look at the whole picture. 13 Q. Can you tell me about the rest of the 14 pulmonary testing done for Mr. Petersen? 15 A. Dr. Barisch is a -- also a chest specialist, 16 like myself. 17 Q. Cam I ask you a little bit about Dr. 18 Barisch before you go into that? How long have you 19 worked with him? 20 A. I've known him for several years. I started 21 ending patients to him a year and a half, two years 22 ago, for further -- more sophisticated pulmonary 23 function testing. He happens to have that equipment in 24 his office. 25 Q. What type of physician is he? RNW 2494 VELEZ - Direct/Tuzzio 50 1 A. He's a board certified chest, same as I am. 2 Q. He just has more equipment? 3 A. Yeah. He's got another $80,000 worth of toys. 4 Q. What did Dr. Barisch do to inform Mr. 5 Petersen? 6 A. Not really much. These are performed by a 7 technician who is certified in the administration of 8 these tests. And then Dr. Barisch basically supervises 9 and then interprets the pulmonary function tests and 10 ensures they're valid testing, testing is going 11 according to protocols that he has set forth and these 12 numbers are valid, basically. He provides me with a 13 report. 14 Q. If I can ask you this question, given 15 the fact Mr. Petersen was presented with the larynx 16 condition and the letter from Levinson indicated no 17 asbestos exposure, why your concentration on the 18 pulmonary testing? 19 A. Because I had said I had his X-ray already. 20 Q. Oh, this was all after you had done 21 your own X-ray or the Mount Sinai X-ray. 22 A I saw Mr. Petersen on August 11th and then I 23 referred him to Dr. Barisch, who saw him on August 24. 24 Q. And by the time he was seen by Dr. 25 Barisch had you already had the conversation with Mr. RNW 2495 VELEZ - Direct/Tuzzio 51 1 Petersen in which he discussed the possibility of 2 asbestos exposure in his past? 3 A. That's correct. 4 Q. So that's when you thought it prudent 5 to follow up with Dr. Barisch, more concentration on 6 pulmonary asbestosis? 7 A. Yes. Then and there. In other words, when he 8 leaves the office, it's all done already. In other 9 words, he has the referral. He's been given 10 instructions to call Dr. Barisch's office for 11 appointment. We have printed forms which I just check 12 off and he takes care of it from there. I wait for the 13 report after that. 14 Q. Why did you do the spirometry in this 15 case? I assume this was done on August 11? 16 A. We do it basically as a screen. 17 Q. And in this case spirometry led you 18 to certain conclusions or suspicions concerning the 19 asbestos history? 20 A* Ho. It was the X-ray. 21 Q. And the X-ray? 22 A. It was really the X-ray. 23 Q. Really the X-ray? 24 A. Right. In other words, as we discussed before, 25 all this is available to me when I go to examine the RNW 2496 VELEZ - Direct/Tuzzio 52 1 patient. 1 looked at the X-ray and then I just knew I 2 had to find out -- I knew he had asbestos exposure, 3 even though there was none that was put forth. 4 Q. Do you have the X-rays here? 5 A. Yes. I do. 6 Q. Can I take a look at those and show 7 me on the shadowbox exactly what in those X-rays led 8 you to think there might have been asbestos exposure? 9 A. Sure. 10 ( Whereupon,discussion is 11 held off the record.) 12 Q. I've asked you. Doctor, to let me 13 take a look at those X-rays of Mr. Petersen and you 14 have a shadowbox in here and you have one X-ray up 15 there. When you get settled if you can just show me 16 the abnormalities that you found. 17 A. The X-rayup there is Mr.Petersen's. It's a 18 standard PA view X-ray entered from the back, chest is 19 against the plaque or -- against the X-ray film, 20 cassette holder. This is a normal X-ray for your own 21 comparison. Regarding the pleura, these are the 22 diaphrams here. 23 Q. Can you describe where they are, left 24 side, right side? 25 A. This is the right side. Diaphragm is the RNW 2497 VELEZ - Direct/Tuzzio 53 1 interface between the chest cavity and abdominal 2 cavity. 3 Q. Where are they on the picture because 4 we're not going to have the benefit as we -- 5 A. There is a marker that says L. This is the 6 left side and this is the right side. This is the 7 right diaphragm and left diaphragm. 8 Q. Towards the lower left side? 9 A. It's lower right side. And what you see here 10 are these white streaks right along the diaphragm. If 11 you look here they're not there. 12 Q. When you say here you mean on the 13 normal X-ray? 14 A. Right. Not on the normal X-ray. That's 15 correct. 16 Q. What you are looking at is 17 calcification or calcium on the diaphragm and that's 18 because there are pleural plaques there. There are 19 one, two, actually three plaques. If you look at the 20 left very faintly there is one there. But this one 21 here is easy to see. 22 Q. This one you mean the white streak? 23 A. That's right. So you have bilateral calcified 24 pleural plaques. 25 Q. Bilateral is for both sides, for lay RNW 2498 VELEZ - Direct/Tuzzio 54 1 people? 2 A. Both sides, ahum. If you look now along the 3 chest wall and it's much clearer to see if you look at 4 the normal, the chest wall ends inside of the rib and 5 then it's contracted against normal lung tissue. Do 6 you see that? This is normal lung tissue comes to this 7 crisscross of ribs. 8 You can see it's real clear to see, you can 9 discern the ribs but there is another line in there, 10 another shadow, do you see that? 11 Q. You are talking about a shadow which 12 makes it difficult to see the other side of the ribs 13 where they are easily crisscrossed in the normal. 14 A. Right. In other words, this shadow actually 15 extends up to here, is not seen here. And that's 16 pleural thickening along the chest -- along the right 17 chest wall. The one on the left is a little harder -- 18 a little -- you can see a thickened process, a little 19 harder to see, but it's over here, and extends up to 20 about here on the left. And that's, again, continued 21 pleural thickening on the left. That pretty much 22 described the lining of the lung or the pleura. 23 If you look at the normal X-ray here, you'll 24 notice that the outer third of the lung can be 25 separated into three straight lines and in contrast to RNW 2499 VELEZ - Direct/Tuzzio 55 1 the inner thirds and middle thirds is basically devoid 2 of any plaques. 3 If you look here there is nothing there. If 4 you look finely you see some fine stipling but in 5 contrast to say here, there is nothing here. If you 6 look at Mr. Petersen's, there is abundance of shadows 7 that continue out pretty much to the end of the chest 8 wall. In here you can see them. In here you can see 9 them. In addition -- 10 Q. What are those shadows indicative of? 11 A. Scarring of the lung or pulmonary asbestosis. 12 If you also look here, you'll notice there is a pattern 13 that tend to follow the -- they tend to eminate -- this 14 is the right interlobar (ph) artery and they tend to -- 15 like a tree, just go out from that. These here are in 16 essence not contiguous with any structure, normal 17 bronchovascular structure. This is characteristic of 18 scarring of the lungs. Those are the two differences. 19 Q. Just again, because the transcript 20 will read one way and then you've been able to as 21 you're explaining to us we've had the benefit to see 22 what you're talking about. 23 Can you just sum up the three or four 24 different abnormalities that you had that you found on 25 the X-rays? RNW 2500 VELEZ - Direct/Tuzzio 56 1 A. The basic abnormalities on Mr. Petersen's 2 X-rays are number one, there is a relative darkness of 3 these lung fields in contrast to the normal X-ray. In 4 addition there is a relative flattening of these 5 diaphrams in contrast to these diaphrams. 6 You can see have almost a half circle and these 7 tend to be flatter. These findings are consistent with 8 chronic obstructive pulmonay disease. 9 With respect to asbestos, there are bilateral 10 calcified pleural plaques on the diaphragm and there is 11 bilateral chest wall plaques, non-calcified. 12 In addition, pulmonary parenchyma has increased 13 interstitial markings, which is consistent with 14 scarring of the lungs or pulmonary asbestosis. If you 15 want to go off the record? 16 ( Whereupon, discussion is 17 held off the record.) 18 Q. There is a way of grading or rating 19 asbestos-related cases? 20 A. That1s correct. 21 Q. And can you explain that rating 22 system to me? 23 A. The pleura is rated by width of the plaque and 24 length of the plaque in relationship to the chest wall. 25 Calcifications axe rated in with respect to the actual RNW 2501 VELEZ - Direct/Tuzzio 1 total linear distance of the calcification. The 57 2 parenchyma is graded by the volume of little streaks, 3 if you want to call it that. Beginning with 0-0, which 4 is normal and all the way up to 3-3, which is the most 5 abnormal. 6 Q. What is Mr. Petersen -- 7 A. I think I gave him 1-1 or 1-0. 8 Q. Does that 1-1 or 1-0 translate into 9 something that you can subjectively say is minimal 10 asbestosis or substantial or -- 11 A. Well -- 12 Q. -- severe? Is that type of disease 13 capable of being rated in those types of terms? 14 A. Yes and no. 0-1, by convention, is maybe 15 positive. More negative, from a legal standpoint it's 16 negative. 1-0 is more positive them negative and from 17 a legal standpoint it's positive. 1-1 is definitely 18 established disease. With respect clinical findings 19 it's very very variable. People with 1-1 disease are 20 very incapacitated. Whereas, others with more than 21 that, 2-2 disease, are not as incapacitated. So it's 22 very variable. 23 Q. Had he, in taking the history from 24 him, had he reported any symptoms which were consistent 25 with asbestos-related disease? RNW 2502 VELHG - Direct/Tuzzio 58 1 A. If you consider his hoarseness, which is 2 asbestos and laryngeal problems, then that was -- he 3 didn't complain of any shortness of breath or coughing. 4 Q. More or less pulmonary type things? 5 A. No. No coughing, no shortness of breath. 6 7 A. Q. Is that suprising to you, normal? No. Like I said it's very variable. 8 Q. Would you expect that as time goes on 9 his symptoms are going to increase, his pulmonary 10 symptoms based on the findings that you made? 11 A. Based on everything, asbestos is a progressive 12 disease. And he could very well begin to have 13 shortness of breath one day. I would expect if it was 14 to progress he would have shortness of breath. So he's 15 still open for that. 16 Q. Did you in coming to your conclusion 17 in this case make any prognosis concerning his asbestos 18 disease? 19 A. I think the report -- I have some standard 20 addendums which I add to reports. If that's not there -- 21 Q. Where you talk about pneumonia and 22 risk, is that what you're talking about in your report? 23 A. That's correct. 24 Q. Can you just, for the record, let us 25 know what your prognosis is for this individual, as a RNW 2503 VELEZ - Direct/Tuzzio 1 result of his asbestos exposure? 59 2 A. Well, asbestos by itself would be with respect 3 to the lung, he has five times greater risk of 4 contracting lung cancer, exclusive of any smoking. He 5 doesn't smoke. And in its simplist form, people with 6 chronic lung disease have weakened lungs and therefore, 7 a pneumonic or pneumonia be much more severe in them 8 than in a regular person. Couple that with his age, 9 it's two risk factors. With mesothelioma, he's at 10 moderate risk for the development of mesothelioma. The 11 risk starts at about around 20 from on set and goes up 12 with time. So as he gets older his risk with 13 mesothelioma will continue to increase. 14 With reference to the GI tract the best you can 15 say is that he's just at increased risk or colon 16 cancer, et cetera. 17 Q. Did we mark Dr. Barisch's report and 18 findings? 19 MR. TUZZIOi Mark this D-3c. 20 (Dr. Barisch's records are 21 received and marked D-3c for identification.) 22 Q. D-3c is Dr. Barisch's report and 23 attachments pages one, two, three, four, and five, 24 which are his test results, essentially. 25 Did you rely upon his report or the test RNW 2504 VELEZ - Direct/Tuzzio 60 1 results in coming to your conclusions in this case? 2 And if so, what did you specifically rely upon and to 3 what degree? 4 A. With respect to a diagnosis of asbestosis, 5 specifically pulmonary asbestosis. Dr. Barisch's 6 testing demonstrates restrictive process. That's card 7 risk of pulmonary asbestosis. 8 In addition, diffusing capacity for oxygen or 9 that amount of oxygen which moves across the pulmonary 10 membranes is also decreased. That's also 11 characteristic. An arterial blood gas which measures 12 the amount of oxygen in the blood was also decreased. 13 And finally, minute ventilation or the amount of 14 breathing that we perform every minute. Normal person 15 takes in and let's out about five liters per minute, 16 five to six liters at rest. 17 Well, while at rest his minute ventilation is 18 elevated. That's characteristic of restrictive or 19 interstitial lung diseases. So putting all this 20 together, this is further information which states that 21 the man has pulmonary asbestosis. Pleural asbestosis 22 is seen on X-ray. 23 MR. TUZZIOs We're going to 24 mark as D-3d the physical examination chart, 25 yellow form. RNW 2505 VELEZ - Direct/Tuzzio 61 1 (Physical examination form is 2 received and marked D-3d for identification.) 3 MR. TUZZIO: And then I'll ask 4 you to refer to that and I'll ask you some 5 questions about your physical examination of 6 Mr. Petersen. 7 Q. What did your physical examination of 8 him consist of? 9 A. It starts with a vital signs, blood pressure, 10 heart rate, height, weight. 11 Q. Before you go any further, were any 12 of those findings significant? 13 A. No. The blood pressure was slightly elevated. 14 Other than that, nothing else. 15 Q. Weight was normal limits? 16 A. 75 inches high. So based -- I guess he also 17 has a big frame. You would expect him to weigh -- he's 18 actually within his weight range. 19 Q. What else did your examination 20 consist of? 21 A. General inspection, which I noted that he was 22 hoarse. His voice was deepened. 23 Q. What did you attribute the 24 hoarseness? 25 A. His laryngeal cancer, chronic hoarseness. The RNW 2506 VELEZ - Direct/Tuzzio 62 1 other abnormality was I noted clubbing of the terminal 2 digits of the fingers. 3 Q. What is clubbing of the digits7 4 A. Some clubbing is just congenital, it gets 5 passed on. In this case I attribute it -- 6 Q. Before I ask you what you attribute 7 it can you explain what clubbing is? 8 A. It's a widening or where the end part of the 9 finger takes on a clubbed or a club type appearance. 10 ( Whereupon, discussion is 11 held off the record.) 12 Q. So clubbing condition is indicitive 13 or attributible to what? 14 A. It suggestive of -- things that cause clubbing 15 or first thing that you ask is was your father this way 16 and has it always been this way. If the answer is yes, 17 it's just congenital clubbing and that's it. People 18 who use jackhammers I think have a tendency to get 19 clubbing of the fingers. 20 8o from the standpoint of cardiopulmonary 21 disease, it's indicative of either heart disease, which 22 comprises the circulation in the lungs or of pulmonary 23 disease, chronic bronchitis, emphysemia and the 24 numerous other -- just about anything within the 25 spectrum of actual primary lung diseases, people with RNW 2507 VELEZ - Direct/Tuzzio 63 1 lung cancer. 2 Q. So the degree of clubbing that you 3 saw is just another factor you put into the equation 4 with regard to pulmonary and asbestos exposure? 5 A. That's correct. 6 Q. What else did your physical 7 examination reveal? 8 A. That's it. 9 Q. What specific examination did you do 10 if any, with regard to his laryngeal condition? In 11 other words did you take a look at it? Did you scope? 12 What did you do for him? 13 A. Basically took the history and noted his 14 hoarseness. 15 Q. If I can ask you why didn't you do 16 anything further? 17 A. I don't have a laryngeal scope here. 18 Q. That's something you can do, right? 19 A. Well, ~ 20 Q. You said you did it. 21 A* It's a bronchoscope, really. To get down to 22 the lung you have to pass the larynx. I wouldn't 23 biopsy or touch a laryngeal mass. I leave that to the 24 ear, nose and threat specialists for numerous reasons. 25 But in his case or from my standpoint I just need to RNW 2508 VELEZ - Direct/Tuzzio 64 1 know -- I just need to know diagnosis. Diagnosis has 2 been made already and I'll comment as an expert on that 3 diagnosis, whether it's causally related or not to any 4 of his exposures. 5 Q. What was his diagnosis concerning the 6 laryngeal situation as you understood it? 7 A. He had been diagnosed as having squamous cell 8 carcinoma of the larynx in 1984. 9 Q. I think you said before there was no 10 tumor, to your understanding? 11 A. With Mr. Petersen? 12 Q. Yes. 13 A. No. He told me his last checkup there was no 14 recurrence of disease. He was left though with chronic 15 hoarseness. 16 Q. What was your understanding of what 17 was done for him by way of treatment of the carcinoma? 18 You can refer to your notes if you want. Take your 19 time. 20 A. What was the question? 21 Q. 22 the cancer? What has been done for him to treat 23 A. I have here a medical history which is listed 24 by the Levinson firm. Which in October of 1978 he 25 presented with hoarseness and lesion of the left vocal RNW 2509 VELEZ - Direct/Tuzzio 65 1 cord. He underwent biopsy about a week later and it 2 revealed hyperkeratosis. 3 Q. What is that? 4 A. The skin, homey layer of the skin, part that 5 you see in the bathtub, the part that peals off, 6 that -- so what happens is the normal, if you look in 7 your own mouth, if the normal pink reddish mucous 8 membrane instead of seeing that what you see is what 9 white plaque and what that means is that that area has 10 transformed from normal squamous cell to one which is 11 hyperkeratotic or has keratin in it. 12 Keratin is on our skin for protection but not 13 necessary within the mucous membranes. 14 Q. Okay. 15 A. And then in May of '79 he had a small tumor 16 which was diagnosed as squamous papilloma, with chronic 17 inflammation. Five years later he was diagnosed as 18 having squamous cell carcinoma of the left vocal cord. 19 Q. Is that just a progression of what he 20 had been previously diagnosed? 21 A. Yes. That's correct. Squamous papillomas have 22 a malignant -- have tendency to regenerate. Couple 23 weeks later they took out a large tumor. 24 25 A. Q. What time frame are we in now, '84? Right. January, 1984. So it's a large tumor RNW 2510 VELEZ - Direct/Tuzzio 66 1 was removed from the left vocal cord. 2 Q. Did they leave the vocal cord in 3 tact? 4 A. They went back a month later and they took out 5 half of his larynx, left side. Then he had some sort 6 of procedure performed, probably to help him talk. And 7 he's been seeing the ear, knows and throat specialist 8 every six months. 9 Q. Did he report to you any recurrence 10 since the hemilaryngectomy? 11 A. No. Just the persistent hoarseness. 12 Q. Did he, when you spoke with him, did 13 he report to you any worsening of the hoarseness, pain, 14 any change in his condition from the time of the 15 hemilaryngectomy? 16 A. No. His hoarseness was fairly established. 17 Q. That's what he reported. 18 A. I'm going on memory. 19 Q. What other documents did you produce 20 here today in response to request number one? I think 21 you gave me everything that's been marked, obviously. 22 Why don't we go off the record? 23 ( Whereupon, discussion is 24 held off the record.) 25 Q. Why don't you look at request number RNW 2511 VELEZ - Direct/Tuzzio 1 one and let me know if there is anything else 67 2 responsive to that request? 3 A. Just the report. 4 Q. 5 cover now. Just the report itself, which we'll 6 MR. TUZZIOx D-4. 7 (Report of Dr. Velez is 8 received and marked D-4 for identification.) 9 Q. Your report was mark as D-4. I'll 10 ask you more questions. Did you make any notes of 11 telephone conversations that you had with the Levinson 12 office? 13 A. No. I didn't. I generally don't. 14 Q. What else did the Levinson office 15 send you to prepare you to write your report in this 16 case, other than what you produced for me? I'm 17 basically talking about request two. 18 A. They provided me with some NIOSH documents, 19 some industriad, hygiene reports. 20 Q. Do you have those with you? 21 A. Yes, I do. 22 Q. Could I take a look at those? These 23 are additional materials given to you by the Levinson 24 firm. Is this just for this case or is this what you 25 have received from the Levinson firm in the past? Is RNW 2512 VELEZ - Direct/Tuzzio 68 1 this all related to Petersen what I'm looking at here? 2 A. That's correct. 3 MR. TUZZIO: I'll want copies 4 of all these. 5 MS. HOROWITZ: Okay. 6 MR. TUZZIO: Next exhibit D-5. 7 D-5 will be an April 15, 1989 letter from Dr. 8 Samuel Epstein to Mr. Levinson, with 9 attachments. Letter describes the attachments 10 as materials incorporated in the report and 11 it's captioned Petersen versus Union Carbide. 12 Can you mark that, please? 13 (Above-referenced document is 14 received and marked D-5 for identification.) 15 MR. TUZZIO: Next document is 16 Dr. Burton Davidson's's report in this case 17 Petersen versus Union Carbide we should mark 18 it anyway. It's D-6. 19 (Above-referenced document is 20 received and marked D-6 for identification.) 21 MR. TUZZIO: Next document is 22 an Engineering Control Assessment of the 23 Plastics and Resin Industry, which appears to 24 have been prepared by NIOSH in inviro control. 25 (Above-referenced document is RNW 2513 VELEZ - Direct/Tuzzio 69 1 received and marked D-7 for identification.) 2 MR. TUZZIO: That was just 3 marked as D-7. D-8 will be an OSHA report 4 dated October 4, 1974 entitled exposure to 5 vinyl chloride. 6 (Above-referenced document is 7 received and marked D-8 for identification.) 8 MR. TUZZIO: The next which is 9 going to be D-9 appears to be labeling for 10 vinyl chloride. 11 (Above-referenced document is 12 received and marked D-9 for identification.) 13 MR. TUZZIO: D-10 is an 14 article entitled Case of Occupational Aero 15 Steolysis Presumably Caused By Vinyl Chloride. 16 (Above-referenced document is 17 received and marked D-10 for identification.) 18 MR. TUZZIO: D-ll will be an 19 article or abstract entitled Statement to 20 Employees in the Vinyl Chloride Industry. 21 (Above-referenced document is 22 received and marked D-ll for identification.) 23 MR. TUZZIO: D-12 is an 24 article entitled Angiosarcoma of the Liver in 25 Vinyl Chloride/Polyvinyl Chloride Workers by RNW 2514 VELEZ - Direct/Tuazio 70 1 Drs. Spirtas and Kammisski. 2 (Above-referenced document is 3 received and marked D-12 for identification.) 4 MR. TUZZIO: The next article 5 is entitled the health hazards of plastics by 6 Drs. Eckert and Hinden. 7 (Above-referenced document is 8 received and marked D-13 for identification.) 9 MR. TUZZIO: Next item is 10 PSNews Briefs February, 1976. 11 (Above-referenced document is 12 received and marked P-14 for identification.) 13 MR. TUZZIO: Next item is a 14 letter from US Consumer Product Safety 15 Commission dated June 17, 1975 addressed to 16 Levinson firm. That letter has attachments. 17 Attachments are described presumably in the 18 June 17 letter as a briefing package on vinyl 19 chloride. 20 (Above-referenced document is 21 received and marked D-14 for identification.) 22 MR. TUZZIO: Next item which 23 is going to be D-15, is an article entitled 24 Vinyl Chloride Induced Liver Disease by Dr. 25 Thomas and others, including Dr. Selikoff and RNW 2515 VELEZ - Direct/Tuzzio 71 1 reprinted from the New England Journal of 2 Medicine January 2, 1975. 3 ( Above-referenced documents 4 are recieved and marked D-15 for 5 identification.) 6 MR. TUZZIOi D-16 is the NIOSH 7 recommended standard for occupational exposure 8 to vinyl chloride. 9 (Above-referenced document is 10 received and marked D-16 for identification.) 11 MR. TUZZIOt D-17 looks like a 12 OSHA regulation 191093Q concerning vinyl 13 chloride. 14 (Above-referenced document is 15 received and marked D-17 for identification.) 16 MR. TUZZIOt D-18 looks like 17 more OSHA standards. It's actually standards 18 for exposure to vinyl chloride, corrections. 19 There is a date on it says December 3, 1974, 20 which is handwritten. 21 (Above-referenced document is 22 received and marked D-18 for identification.) 23 MR. TUZZIOt D-19 is a letter 24 which appears to be dated June 18, 1975 from 25 the Department of Health, Education and RNW 2516 VELEZ - Direct/Tuzzio 72 1 Welfare to Senator Harrison Williams. 2 (Above-referenced document is 3 received and marked D-19 for identification.) 4 MR. TUZZIO* D-20 is a cover 5 letter dated April 21, 1975 which makes 6 reference to attachments, attached copies of 7 OSHA program directive on vinyl chloride 8 signed by R.N. Wheeler, Junior. 9 (Above-referenced document is 10 received and marked D-20 for identification.) 11 MR. TUZZIO* D-21 is a 12 statement of Dr. Marcus M. Key, dated August 13 21, 1974. 14 (Above-referenced document is 15 received and marked D-21 for identification.) 16 MR. TUZZIO: D-22 is an 17 article entitled Multiple Primary Malignant 18 Neoplasms in the Air and Upper Food Passages, 19 by Dr. Epstein and others. 20 (Above-referenced document is 21 received and marked D-22 for identification.) 22 MR. TUZZIO: D-23 is a cover 23 letter from Mr. Levinson to Dr. Velez dated 24 October 23, 1989. 25 (Above-referenced document is RNW 2517 VELEZ - Direct/Tuzzio 73 1 received and narked D-23 for identification.) 2 MR. TUZZIO: D-24 is a 3 three-page document which is entitled John 4 Petersen up in the left-hand corner. It 5 appears to be one of the enclosures for the 6 August 23, 1989 letter from Mr. Levinson to 7 Dr. Velez. 8 (Above-referenced document is 9 received and marked D-24 for identification.) 10 MR. TUZZIO: D--25 is Dr. 11 Epstein's preliminary report in this case, 12 Petersen versus Union Carbide. 13 (Above-referenced document is 14 received and marked D-25 for identification.) 15 MR. TUZZIO: D-26 is a NIOSH 16 technical information document titled Cross- 17 sectional Epidemiologic Survey of Vinyl 18 Chloride Workers. 19 (Above-referenced document is 20 received and marked D-26 for identification.) 21 MR. TUZZIO: D-27 is a cover 22 letter with attachments from a Joseph K. 23 Wagoner to Dr. Epstein. And attachment is a 24 paper entitled Vinyl Chloride-Polyvinyl 25 Chloride, Review of Carcinogenic and Other RNW 2518 VELEZ - Direct/Tuzzio 74 1 Toxicologic Effects. 2 (Above-referenced document is 3 received and marked D-27 for identification.) 4 MR. TUZZIO: And D-28 is a 114 5 page document entitled Worker Exposure to 6 Vinyl Chloride in Vinyl Chloride and Polyvinyl 7 Chloride Production and Fabrication. 8 (Above-referenced document is 9 received and marked 0-28 for identification.) 10 ( Whereupon, recess taken.) 11 Q. Anything else than what I've just 12 marked that big package of materials forwarded to you 13 by the Levinson office that would be in response to 14 request number two, all materials supplied to you by 15 the Levinson office? 16 A. That's complete. 17 Q. Okay. What about request number 18 three, which I'll read into the record,"All 19 communications between you and any other person 20 relating to this litigation or the issues raised 21 therein, including but not limited to correspondence, 22 memoranda, reports, notes regarding telephone 23 conversations and other conversations and the like." 24 Some of the stuff might overlap from one 25 request to another. RNW 2519 VELEZ - Direct/Tuzzio 75 1 Is there anything that we haven't marked yet 2 which is responsive to this request? 3 A. I had a brief conversation with Dr. Epstein, 4 who was the author on one or two of those papers. 5 Q. Did you make notes of that 6 con ver s at i on? 7 A. No. It was just a sort of call talking about 8 risk factors, laryngeal cancer, et cetera. 9 Q. Did you rely on anything which he 10 told you in that conversation in coming to your 11 conclusion in this case? 12 A. No. It just -- I just wanted to talk to him. 13 It's all sort -- I may have picked out a piece of this 14 and piece of that. But I was actually -- it was 15 more -- I had certain questions I wanted to ask him. 16 Q. What types of questions did you ask 17 him? 18 A. Same sorts of questions you asked me before 19 about relative risk and if there was a good body of 20 information about things of that nature. 21 Q. Relative risk of what? Concerning 22 what? 23 A. In an attempt to try to decide whether vinyl 24 chloride was a weak, strong -- a weak or strong 25 carcinogen. In looking at literature, there is. -- it's RNW 2520 VELEZ - Direct/Tuzzio 76 1 not clear, let me put it that way. 2 3 A. Q. Okay. There is data that says it is strong. 4 Q. Okay. What did he tell you that he 5 thought it was weak or strong or did he agree with you 6 it was unclear from the literature? 7 A. He couldn't put a number on it. That's what he 8 was able to tell me. 9 10 A. Q. What did that mean? In his opinion. 11 Q. What does that mean? 12 A. We talk about cigarette smoke ten times the 13 relative risk. That you couldn't put a number on it. 14 And put it into that type of framework. 15 Q. I'm still not understanding what you 16 mean by putting a number on it. 17 A. If you were to say to me Doctor, how would you 18 rate cigarette smoking as carcinogen I would say to you 19 that it's a strong carcinogen and you'd ask me what do 20 you base your opinion on, and I'd say relative risk of 21 ten, or ten times that of the general population, makes 22 it a strong -- 23 Q. Now, if I were to ask you that same 24 question with regard to vinyl chloride? 25 A. Yeah. There are no actual numbers. But there RNW 2521 VELEZ - Direct/Tuzzio 77 1 are some evidence in some of the studies that even 2 after you correct for smoking, which is a strong 3 carcinogen or removed the smoking component, that when 4 collected for smoking there is still or when included 5 for smoking, that the vinyl chloride is still working 6 as carcinogen. It's not overshadowed, let's say, by 7 the smoking. 8 Q. But you can't put the kind of number 9 on it as you can with cigarette, such as nine times 10 that of the general public? 11 A. It would have to be strictly my opinion. And 12 strictly just theorizing. You can say that after you 13 account for smoking it still comes through, that it's a 14 very strong carcinogen. In addition, it appears to 15 have both animals and humans multiple organ 16 carcinogenicity. Again, making it a potent carcinogen. 17 Q. What else can you tell me about the 18 conversation that you had with Dr. Epstein? 19 A. That's it. It was a brief conversation. 20 Q. Had you met him before? 21 A. No. I had heard his name and knew of him. 22 Q. Did the conversation with Dr. Epstein 23 change any opinion you had with regard to any aspect to 24 this case, and particularly vinyl chloride's role as 25 carcinogen? RNW 2522 VELEZ - Direct/Tuzzio 78 1 A. No. None really. I was, if anything, I was 2 looking for more information. 3 Q. And did you get more information from 4 him? 5 A. No. I was trying to get that information that 6 we just discussed. He was not able to help me with 7 that. 8 Q. Number request four, if you can look 9 at it requests all materials which you have reviewed, 10 consulted, read or considered in anyway in reviewing 11 this litigation and issues raised therein and in the 12 rendering of your opinions. 13 A. I've seen other things. I have small library 14 at home. And I have access to library, of course in 15 the hospitals. And I'm also in the process of 16 requesting specific information. None of which I have 17 for you now. 18 Q. You don't remember what else you've 19 read other than what you've -- well, first off, that 20 large packet of documents I marked that you got from 21 the Levinson firm which would be D-6 through D-28 or 22 so, did you review all those materials? 23 A. Yes, I did. 24 Q. And did you rely on any of those 25 specifically in coming to your opinion in this case? RNW 2523 i VELEZ - Direct/Tuzzio 79 1 A. Yes, I did. 2 Q. Do you remember what you specifically 3 relied on? 4 A. There are -- there is quite a bit of 5 information in there, as you can see. There is 6 certain -- couple of reviews which are always helpful 7 because the reviews look at all the literature. And it 8 helps you gain prospective. Those were probably the 9 most helpful reviews. 10 Q. Is it your recollection that package 11 of materials dealt with primarily vinyl chloride? If 12 you want to take a look you can? It was my impression 13 looking at them, the vinyl chloridematerial. 14 A. That's correct. Yes. 15 Q. And what else did you look at besides 16 this in your personal library or at the hospital 17 library that would have -- that you relied upon in 18 coming to your conclusion? 19 A. Standard pathology texts. 20 Q. Can you tell me exactly what they 21 are? If you relied upon them I'd like to know exactly 22 what -- 23 A. Robbins Textbook of Pathology is one. 24 Q. Do you remember what part of Robbins 25 you looked at? RNW 2524 VELEZ - Direct/Tuzzio 80 1 A. Under laryngeal cancer. The -- I have a couple 2 of monographs at home regarding chemical carcinogenesis 3 from the American Society of the Sciences. 4 Q. Did you rely on those in coming to 5 your conclusion in this case? 6 A. Yes, I did. 7 Q. Could you send copies of those to the 8 Levinson office please? 9 A. I'll send the front and you can always request 10 them. You are asking me to copy a whole book. 11 Q. These are from textbooks? 12 A. No. They're monographs. 13 Q. Do you remember specifically what you 14 looked at? 15 A. Just -- I just remember the New York Academy of 16 Sciences. They're well known for publishing these. 17 Q. Anything else? 18 A. And like I said, I have a few minutes to look 19 at a couple things in a library. There is Journal of 20 Occupational Medicine, which stands out. Exact ones I 21 can't tell you. 22 Q. Did you make copies of things you 23 looked at? 24 A. I'm requesting all of that. 25 Q. And after you've had copies of those RNW 2525 VELEZ - Direct/Tuzzio 81 1 made could you send copies or at least titles of the 2 articles to the Levinson office? 3 A. Yes. Copies will probably be fine. 4 Q. I'd appreciate that. Anything else 5 that you looked at in coming to your conclusion in this 6 case, which would be in response to request number 7 four? 8 A. No. That pretty much covers it. 9 Q. Request five, all written reports 10 including drafts and memoranda notes or on 11 documentation relating to oral reports rendered in this 12 matter. 13 Did you do anything, draft anything other than 14 the August 15, 1989 report in this case? 15 A. No. Just what you see. 16 Q. Did you do a rough draft in this 17 case? 18 A. Yes. 19 Q. Do you have the rough draft? 20 A. No. It gets thrown away. 21 Q, Did you dictate the rough draft to 22 somebody? 23 A. I have a dictation system, mechanical system. 24 I dictate. It gets onto microcassettes and then the 25 typist takes the microcassette and uses the word RNW 2526 VELEZ - Direct/Tuzzio 82 1 processor and then I get a dot matrix copy. 2 Q. Do you know if that tape still exists 3 that you dictated? 4 A. Probably not. 5 Q. Was this an outside service that did 6 this for you? 7 A. No. Just someone who -- she does it in her 8 home. And she mails this, the hard copies in. 9 Q. Does she still have the draft on 10 memory, do you know? 11 A. No. We have the disk here. 12 Q. Do you have the disk? 13 A. But the disk has been corrected. 14 Q. So you wouldn't have the original of 15 your report? 16 A. No. I can tell you the original is this 17 report. 18 Q. Do you remember what changes you 19 made? 20 A. Typos. Typos. That's all. 21 Q. There were no changes in the 22 substance of the findings that you made from the time 23 of your first draft up until this final product, August 24 15, 1989? 25 A. No. This is what you see is what I basically RNW 2527 VELEZ - Direct/Tuzzio 83 1 put together originally. 2 Q. Request six is on the next page, "All 3 reports, written and oral correspondence and memoranda 4 prepared by you independent of the Petersen litigation 5 relating to the toxic properties of any chemical 6 including but not limited to polyvinyl chloride and 7 vinyl chloride monomer, alleged to have caused Mr. 8 Petersen's injuries or illnesses in this matter." 9 A. I have nothing. 10 Q. You've never written another report 11 pertaining to the toxic properties of any chemical. 12 That's what it's asking you for. 13 A. Of any chemical? 14 MS. HOROWITZ: It says 15 specifically. 16 MR. TUZZIO: Including PBC. 17 A. I have certain publications on dioxins. 18 Q. What about reports? 19 A. No. No, I haven't. No. 20 Q. What are the publications on dioxins 21 you've written? 22 A. The first one was in JAMA, Journal of American 23 Medical Association, March of '88 or '89. We have a 24 copy of it here. And subsequent to that there were 25 three more publications on dioxins, which were recently RNW 2528 VELEZ - Direct/Tuzzio 84 1 published in Chemisphere. And we may have -- I think I 2 have those. I'm sure we have them. 3 Q. Have you ever written another report, 4 I might have asked you this before, concerning PBC or 5 VCM? 6 A. No. 7 Q. You've never treated or examined for 8 any purpose a person in which you've been asked to 9 describe any kind of exposure he might have had to PBC 10 or VCM and then subsequently written a report? 11 A. Yes. Those cases. 12 Q. From the Wilentz office, right? 13 A. That's correct. 14 Q. I'm going to request copies of the 15 reports that you wrote in that case. 16 A. There is 100 reports. 17 Q. I know that. I figured that. You 18 can talk it over with Mr. Levinson's office. I'll make 19 that request and follow up with a letter. 20 A. I know what you want. But I don't know how 21 you're going to do it. I really have no reason, if you 22 want to see them and I know you're entitled to them but 23 I can tell you personally, I don't have the time to 24 copy 100 reports for you. 25 MR. TUZZIO: Why don't we just RNW 2529 VELEZ - Direct/Tuzzio 85 1 note the request at this point. We'll talk 2 with the Levinson office about it and we'll 3 get back to you. We don't have to discuss it 4 right now. Okay? 5 Q. In the literature you reviewed did 6 you ever review any piece of literature which talks 7 about the -- any kind of connection between cancer and 8 exposure to polyvinyl chloride? 9 A. Oh, yes. 10 Q. And what specific pieces of 11 literature talks about that? And you can review 12 that -- 13 A. We're talking about review articles that are 14 noted here. 15 Q. Which would be what? 16 A. They're in this pile that's in front of me. 17 Review articles about the multi-organ carcinogenicity 18 of vinyl chloride. 19 Q. Could you show me exactly which ones? 20 Just go through and give me -- 21 A. Standard text all talk about the vinyl 22 chloride. I mean, it was a hot topic in the '70s. 23 This is pretty much in the standard textbooks. Those 24 were the original reports about angiosarcomas. 25 Q. We're talking about what's been RNW 2530 VELEZ - Direct/Tuzzio 86 1 marked as D-15 vinyl chloride induced liver diseases by 2 Dr. Thomas and others. 3 A. There was a quick and dirty review by Dr. 4 Epstein right here. You -- actually there are two of 5 these but one is missing, the part on PVC, vinyl 6 chloride. 7 Q. What is the exhibit number on that? 8 That's D-25. And that's actually Dr. Epstein's report 9 in this case. 10 A. And actually D-5, is the same report missing 11 the vinyl chloride. 12 Q. You relied on that in coming to your 13 conclusion in this case? 14 A. In part, yes . 15 Q. What specifics talk about Dr. 16 Epstein's report? Did you rely -- 17 A. I'd have to read it again and talk about it. 18 This was helpful, NIOSH technical document. They 19 usually are very helpful. I think one of the helpful 20 things is the documentation that even though 21 preliminarized there is still the monomer or the vinyl 22 chloride monomer is still and still, I guess I call it 23 degassed from the polymer. There is just some stuff on 24 animals which is interesting but bottom line is that we 25 always, you know, too many inconsistencies between RNW 2531 i i i i I VELEZ - Direct/Tuzzio 87 1 animals and humans. So like I say, it's interesting. 2 Then there is short -- well, there is a review about 3 the human factors. That's page four of the D-25. And 4 then cites quite a few references. 5 Q. Did you go check those references or 6 did you rely upon what Dr. Epstein -- 7 A. Some of those I've already -- Will Lillis is 8 the one I remembered from -- 9 Q. Could you describe that more fully 10 for the record? 11 A. This had been done, that is one by Miller and 12 Lillis, et al, 1975 and Miller, et al. Dr. Miller was 13 also in the pulmonary department at Sinai. I remember 14 they had done seme of this work and there had been a 15 associations made with chronic bronchitis, obstructive 16 lung disease. Seme of it I'm trying to get. That 17 takes care of that one NIOSH document. 18 Q. That's D-26, right? 19 A. D-26, that's correct. 20 Q. What did you rely on from the NIOSH 21 study? 22 A. They went mainly into the lung problems, 23 chronic obstructive pulmonay disease, chronic 24 bronchitis and airway abnormalities they talked about 25 liver. They didn't have much to say about other RNW 2532 VELEZ - Direct/Tuzzio 88 1 things. There was a good review here by Dr. Wagoner. 2 Q. What is the exhibit number? 3 A. D-27. Which -- essentially he reviews the 4 toxicity of vinyl chloride and asbestos, multiple organ 5 toxicity, more specifically, I think multiple organ 6 carcinogenicity of vinyl chloride. This was just an 7 industrial hygiene study, D-28. 8 Q. Did you rely on that at all? 9 A. No. It's pretty useless to me. 10 Q. How do you rate or are you aware of 11 any piece of medical literature which has linked the 12 laryngeal cancer with exposure to polyvinyl chloride or 13 vinyl chloride monomer? 14 A. Well, this body of information here and 15 following up on some of these sources as I stated New 16 York Academy of Sciences has a couple of monographs on 17 chemical carcinogenesis and they talk about -- one of 18 them talks about the multiple organ carcinogenicity of 19 PCV and VC. 20 Q. My request is a little bit more 21 specific and I know we're running out of time. But I 22 want to know what articles in that pile or any other 23 article that you're aware of that specifically deal 24 with or have set forth any kind of causal connection 25 between cancer of the larynx and exposure to PVC or RNW 2533 VELEZ - Direct/Tuzzio 1 VCM? 89 2 A. One that's most complete is the Epstein review. 3 Q. The review is the litigation report 4 in this case? 5 A. Yes. 6 Q. Do you know what he relied on to come 7 to the conclusion -- 8 A. He gives you a bibliography there that you can 9 follow up on. 10 Q. Other than what you read in Dr. 11 Epstein's report, litigation report in this case, are 12 you aware of any medical literature which makes a 13 causal connection between exposure to polyvinyl 14 chloride or vinyl chloride monomer and and cancer of 15 the larynx? 16 A. Like I said, Academy of Sciences there is 17 mention there where they talk about they actually refer 18 back to the NIOSH document where there was am excess of 19 respiratory system cancers, meaning the whole nose, all 20 the way down to the lung. 21 Q. And you don't know the date or title 22 of that New York Academy of Science? 23 A. No. I have it at heme. It's an old one. 24 That's the ones I told you I'd get for you. 25 Q. Is there in your medical experience. RNW 2534 VELEZ - Direct/Tuzzio 90 1 is there a large body of literature concerning 2 connection between larynx cancer and polyvinyl chloride 3 or vinyl chloride monomer exposure? 4 A. No. In comparison to other literatures it's 5 smal1. 6 Q. Again, the articles that Dr. Epstein 7 cited, did you look at them to see if any of them 8 specifically talk about larynx cancer? 9 A. Those are the ones in the process of having 10 pulled. 11 Q. Upon what did you base your opinion 12 in this case that Mr. Petersen's larynx cancer was 13 related to polyvinyl chloride or vinyl chloride monomer 14 exposure? 15 A. Whole overall picture? 16 Q. Well, let me just go to your report. 17 It's been marked as D-4. In addition, your assessment 18 on page three of your report in addition his laryngeal 19 cancer is causally related to long term exposure to 20 vinyl chloride. How did you come to that conclusion? 21 A. Again, based on, well, number one, knowing he 22 has the problem. Number two, exclusion of other known 23 causes. 24 Q. What other known causes did you 25 exclude? RNW 2535 ! VELEZ - Direct/Tuzzio 91 1 A. The big ones; cigarette smoking and drinking. 2 Q. What about asbestos? 3 A. That would be -- that's included in the report. 4 Q. Well, did you conclude anywhere in 5 your report that the laryngeal cancer is related to his 6 asbestos exposure? 7 A. I think that with the information supplied, 8 that it's quite obvious. 9 Q. Do you have an opinion to reasonable 10 degree of medical probability as to whether or not his 11 laryngeal cancer is causally related to the asbestos 12 cancer? 13 A. Asbestos is a known carcinogen for the larynx. 14 Therefore, I would -- it would be my opinion that there 15 is a causal relationship. 16 Q. What about to a reasonable degree of 17 medical probability, do you have an opinion that his 18 laryngeal cancer is causally related to his exposure to 19 vinyl chloride? 20 A. It would be the same. It would be my medical 21 opinion based on what I have in front of me, that -- 22 Q. What do you have in front of you? 23 A. I mean talking generically what I've looked at 24 and that is causally related. 25 Q. What is the basis for that? RNW 2536 VELEZ - Direct/Tuzzio 92 1 A. Information supplied here. 2 Q. What specific information? Again, I 3 know we're sort of running out of time, we'll come back 4 and finish this another day but I want the know exactly 5 what piece of literature you're relying onto say there 6 is a connection between larynx cancer and vinyl 7 chloride exposure? 8 A. As I stated before, there is review article by 9 Wagoner, which is actually in greater depth than the 10 Ebstein review. Where the multi-organ carcinogenicity 11 of vinyl chloride is covered. 12 Q. Did you read the Wagoner report 13 before you drafted your opinion in this case? 14 A. Yes, I did. Yes. 15 Q. Can you show me where in his report 16 he talks about larynx cancer? I've never seen it. 17 A. He makes mention on page one, excesses of the 18 buccal cavity which is basically the mouth and upper 19 ai rways. 20 Q. What does he say specifically? 21 A. He calls it the buccal cavity. 22 Q. Can you spell that? 23 A. B-U-C-C-A-L. 24 Q. And what does he say about the buccal 25 cavity that in anyway supports your opinion? RNW 2537 VELEZ - Direct/Tuzzio 93 1 A. One or more studies showed excesses of buccal 2 cavity. And he states on page two increase frequency 3 of breasts cancer, lymphatic cancer and respiratory 4 tract cancer. 5 Q. Does he mention larynx specifically 6 there? 7 A. Again, page three of the second part of the 8 same one, again, buccal cavity and pharynx and then 9 respiratory system. 10 Q. What did he say about them? 11 A. Excess. And he's quoting Gaffey. 12 Q. What do you mean excess? 13 A. Excess, retrospective study where cancer was 14 found in excess in a group of what would be expected. 15 Q. Okay. 16 A. The mention is to the respiratory system. He 17 doesn't say in here specifically, he doesn't say 18 specifically larynx. 19 Q. Is it your experience in publishing 20 those types of works and in reviewing those types of 21 works if there was a significant causal connection 22 between something like larynx cancer and exposure that 23 it would have been mentioned more specifically? I know 24 we can't ask you to read Dr. Wagoner's mind but on the 25 other hand -- RNW 2538 VELEZ - Direct/Tuzzio 94 1 A. The answer to that question is that's why if 2 you are going to do it thoroughly you go to the 3 sources. You go to what it is they reviewed in order 4 to make your own final opinion, let me put it that way. 5 Q. So in other words. Dr. Wagoner's 6 article was a review? 7 A. I would consider it a review. 8 Q. And to be sure whether or not he 9 intended or meant to include larynx cancer in his 10 review you'd have to look at those sources yourself? 11 A. That's correct. Yes. 12 Q. Did you in fact look at any of the 13 sources he cited there? 14 A. That's what I'm in the process of doing now. 15 Q. Okay. 16 A. When I have those available I'll -- since we 17 will get together again. 18 MR. TUZZIOt It looks that 19 way. 20 A. Hopefully I'll have those for you. 21 ( Whereupon, discussion is 22 held off the record.) 23 Q. And again, the same with regard to 24 Dr. Epstein you'd have to look at his sources? 25 A. That's correct. RNW 2539 i VELEZ - Direct/Tuzzio 95 1 Q. Okay. But you've, nonetheless, made 2 the statement that the larynx cancer is as a result of 3 vinyl chloride exposure. 4 A. Yes. 5 Q. Have you read anything yourself that 6 leads you to that? 7 A. Yes. Based on what I reviewed, which is 8 basically materials submitted and a few things I've 9 been able to look at myself, independent of what's been 10 provided, it's my opinion at this time that there is 11 enough of a body of literature which would support that 12 contention that vinyl chloride does produce laryngeal 13 cancer. 14 Q. But you can't tell me as you sit here 15 exactly what body of literature you're talking about, 16 other than what you've told me about Wagoner's more 17 general type review? 18 A. The, as we discussed before, the body of 19 literature is not that large. And it's all cited there 20 for you. 21 Q. Is the body of literature larger with 22 regard to a causal connection between asbestos exposure 23 and laryngeal cancer? 24 A. Probably. 25 Q. Do you have an opinion in this case RNW 2540 VELEZ - Direct/Tuzzio 96 1 as to what degree the asbestos played in the onset of 2 the laryngeal cancer as opposed to exposure to 3 polyvinyl chloride? 4 A. It's a very difficult question to answer. 5 Simply because asbestos is a known potent carcinogen. 6 Vinyl chloride is also a known potent carcinogen. How 7 you can -- the only way you can pose one against the 8 other is in the absence of the other, really. And 9 that's not the case in Mr. Petersen's situation. 10 Q. In the absence of exposure to PBC or 11 VCM, would you be comfortable in saying that's to a 12 reasonable degree of medical probability his condition 13 was a result of asbestos exposure? 14 A. If that was the only, -- 15 Q. That's what I mean. 16 A. If that was the only discernable risk factor or 17 causative agent then I would go on record as saying 18 that. Yes. 19 Q. That asbestos did it? 20 A. That's correct. 21 Q. Can I ask you why you didn't say in 22 your report that asbestos caused his laryngeal cancer 23 specifically in your assessment? 24 A. It's no particular reason. I mean, I would 25 expect anyone who read that report to know asbestos was RNW 2541 VELEZ - Direct/Tuzzio 97 1 am agent involved in this. 2 Q. Did the Levinson office ask you to 3 come to a specific conclusion concerning polyvinyl 4 chloride or vinyl chloride monomer and laryngeal cancer 5 as opposed to ask you to come to conclusion regarding 6 asbestos exposure and laryngeal cancer? 7 A. They just -- their request was for an opinion 8 on the case, based on the facts before me. And the 9 report basically states that. And asbestos exposure 10 and the -- it's inescapeable. You'd have to agree. 11 MR. TUZZIO: This is probably 12 a good time to break. 13 For the record, I've got an 14 hour, to hour and a half more of questioning, 15 couple different areas I have to explore. The 16 Doctor has patients that are coming so I 17 reserve my ricpit to continue and of course 18 counsel has no objection. 19 MS. HOROWITZ: No. 20 MR. TUZZIO: And neither does 21 the Doctor. 22 ( Whereupon, proceedings were 23 adjourned at 3:30 p.a.) 24 25 RNW 2542 98 1 CERTIFICATION 2 3 4 I, MAUREEN RATTO, a Notary Public and Certified 5 Shorthand Reporter of the State of New Jersey, do 6 hereby certify that prior to the commencement of the 7 examination HENRY VELEZ was sworn by me to testify the 8 truth, the whole truth and nothing but the truth. 9 I DO FURTHER CERTIFY that the foregoing is a 10 true and accurate transcript of the testimony as taken 11 stenograph!cally by and before me at the time, place 12 and on the date herinbefore set forth. 13 I DO FURTHER CERTIFY that I am neither a 14 relative nor employee nor attorney nor counsel of any 15 of the parties to this action, and that I am neither a 16 relative nor employee of such attorney or counsel, and 17 that I am not financially interested in the action. 18 19 20 License No. XI01165 21 22 23 24 25 RNW 2543 99 1 2 HENRY VELEZ 3 By Mr. Tuzzio INDEX DIRECT 3 CROSS 4 5 6 NO. D-l 7 D-2 D-3a 8 D-3bi D-3bii 9 D-3c D-3d 10 D-4 D-5 11 through D-2 8 12 INDEX TO EXHIBITS DESCRIPTION Notice bp take deposition Letter of 8-8-89 Medical History Pulmonary testing reports Pulmonary testing reports Dr. Barisch's report Physical exam Expert's report of Dr. Velez Documentation sent to Dr. Velez by the Levinson firm PAGE 22 24 35 45 45 59 60 67 68 thru 74 13 14 15 16 17 18 19 20 21 22 23 24 25 RNW 2544