Document Bv3Oq6zbbvev9M4DqNDz54NQE

STANDARO FORW FOR EMPLOYER'S FIRST REPORT OF INJURY OR ILLNESS . fea OKICMAL la iMWrrtlAl ACOOERT BOARD. Lni Ba.ati jamua tat. *. Tat. 'mi <1 w>m a mtm (Off 0>l 1 * W flu. 3 JO* <**-- Of 'NCaMCifr t l--'WM 9 < tfKJMCl* 01MB ye*me sun at* onod. Mat anMiiNifi. : ;'i:XE**at inwag tpr tmmm to ca-- mft am *snuc:>c>n fee T. Art** 4X7. E--Wt uafelift Lam l tmPLOvi.'os msuoance Associa non /O *" A 1 ' 1671-501 THESE SPACES MOT TO BE FILLED IN BY EMPLOYER Siaa 1 Cnrur Eawv p ' No OLiCv OiSTfciCT OOLICV sumBEN 3SHA r.io No Claim num* EPP w*0 ft ClaSSiP CCCE COMPENSATION s oesct*T'ON op acc cent Cat OP WEEK hOuP OP Cay The Dow Chemical Co. Acct. # ; 3"<cr aoorru Ac. and 5!. txm imuiv ina curic Freeport. nor* Z"** atUH 0> Uusintu < OrtlCA UMICVMI . Magnesium and Chemicals , 713 238-3702 < Texas ran. 7 7541 Polity AC. ` a .:at'or> o' rm\ y 3-act *** acc-w ocaarod. me $)*<-. :< KCiMW Y.'ip T tfC'Gtr S 55 Vt1 no. ***** *,< _ Boi-ljT Shop ' in < IN i*C k: 0nj oc^ir m SaiftKC. aMOCTfOMne, Mft. Vift or <!' __ 5 3jlt S' miir* 8/ "^ 5------------------- ;j---------- Day Of I " P.rS* jfUOW !0 AOI. JECL- a fi>r j<j 5' 'or*--* 6jj ibo oi 'fffirr' 6/18/75 rj^ Freeport .-^Brazoria aaTexas ?.,r-- 77541 jitvuni rtptar* t--`OHd m- . A M. . :o . pj. Of Day - AJM . I. las m|wre paid in Nilor rtn* day* pji. Name of Tfuuiod _ fecial V-*N He.. Address Nc and St T*WfP9W No____ _ t. Aft 5' s*i M3_lS^ _ ,c Mantai Statin ------- City or Toi cwunoM No. Ft--o or ffciatm_ . Slat* fetak EltftrBl (4) Minor OW--. Q Yt* Zip Coda . I 1 i Occupai** --on mnadd. ipi Vu ons his or Mr nfuia aco-t--' if not stata m --at Moan--at or pratai of --n 't^iiariY --payed) !6 .ai -- *awy aagiorofl Py ya - 17 li No lam win _ g --__ ffc! P*#a or !i*t _ _ !&l daft* prOay 7T5. ZO +_______ time ci No. aairs Mrufi pr . ci lafts pe -- !. 4) A--aft marr amfs J _ t ' ooarfl. i00fin|. toti or otnr ao^amafti mn iirnM <n Mditron to --fts, |i* tstiand aarut aiut ocr oar. *m ot m*. j Was invito e^oioirtt oHicr flirtctor. sortM*. or ornimf' MaOR< loo. or OiPf cauSM( inr. 20. km] of pom it--d. to*i. ancmcai, sn--. ttc.i 21. of AaaiiM *i0i aanam occurrM. a aa** Tie satm Joo<<a*ct n NtviM'on pot--d _ b i tas a m at t>v .:=.-HM-.^ ---cHas been waller ntaTrer" jnd-expabeQ Lu asbestos >scfje tvib, ho* aernenf ocarm me cart anal --o+orot --i em( *m p--e ------------- ninrp unrVing for Dow. ------------------------------------------------------------------------------------------------- _ Naes *e aoartssas of tMUB. OO 24 >sc''M tw .fi/ury * Hiness p detail m ndicaic om pan of body affaciad. Asbestos is P'0b*N Wftftn of SlUNility . NTL if so. date ml ft-- - A! Ml KCuPIti* - a Nat ano aoorns of pnrsiciaifll a-->. Name and Mdrtss of to--taf n Mo--i _ Dr. Gay~ Industrial Medicine .21 Hw ntwsd ftl*Md to --a/ _____At mat aift i _ 2 11 _________________________ll a. |.uu * (J____________________________________________________________________ - ,,7/18/75 r,m -- For records The Dow Chemical Co. Felix Ainsworthoit.ii. -CO -PO INDUSTRIAL ACCIDENT BOARD REQUIRES COMPLETION OF ALL APPLICABLE ITEMS ON THIS FORM tvl vj standaro form for EMPLOYER'S FIRST REPORT OF INJURY OR ILLNESS *. M CO'GIMl I* HOUSTtUL ttOOUT 80**. lpW i*>nm Ml. Aon. Tn. 'Vtl it iim n i iroa *v> ten Mam. 8. Jaw ttrtfKia* * TWO-ay a ai'na a i( mamoet m wywa i-ity aw aaa mmmm 1671-501 THESE SPACES NOT TO BE FILLED IN BY "fMPtnypp' Aoort Carwr im\Ofor ftit f. %*.POLICY Oi STRICT POLICY NUMBER PSHA f>it n. CLAIM NUMBER accident Oats EPP MO. A YR, inC. TYPE CLASS! F CODE KEY NO. COMPENSATION mEOiCau ss OESCRtPTiQN OP ACCiOCNT CxEn$E % coverage inPO. CaarO . LATE PEP. AOJ. IN. OAY op WEEK HOUR OP OAY length op e*p. DAILY WAGE > 1 *m. aEtiy The Dow Chemical Co. Acct. # " 2. oiict luma m. am SL . . City a t-- Freeport 3 j maw txm mwjY-- iniuatnc* Aocwnon - . r.^) i..u nriMi Magnesium and Chemical3 riWMI. 713 238-3702 TPM5 7rw. 77541 Policy No.. V 41 Lxrio a plant m piact wtn accrdant ocom. * art fiioat _ D< accievn act* an awrevr i 5S tn uZ *** inwic B o ilex S hop 31 M .fiurfC I aifjc^aan^ ^ an wrtact. jtfarfrouM. Mft. ant! ar nm' ___ * l Data a W|\rr___ "i7 \iJ___________________ SayatatM. ^ 7 First tn *5' to NTL -- ----------_ 79_ 9 Ikon drt aa or lerewa* trtIt kk<ww 9l 6/18/75 Freeport r--Brazoria ,u. Texas ... ttovsufft rapUriy ai^igpR - _ ------ _ __ Row 0/ Or . Ail.. . PJL 1. Vas mprtd part m full for Bis day*. 10. Nana a* forweai. 77751 PJI. 11. Plawe 0' Wfored __ Sxut SaearN No.. 12. lasmi No. ana fi __ City er Ton___ . fiaa- Zip Cooa ll. Tewwia-- No. Teiepnene no. Friend airn* Spain CAfi'U Q Yet PR U. la) Aftlb) i** aK IS. (a) Occupation often MalS_ (C) ta,ui fiian (d) Ktaar QntPRi. ftl Vas this his ar har rejitar ocaanttan'. 1 ft net ttaa m Mi# ar brand) at wort ra^tany MjHaynd). 1( ft) how tanf Mpieyrt hy yen. 5 17. 11) PR noun ar say. 8 TTg.^61.'a a iw teniT (bl l*tll tar eiy time 1 el Pie. days p* --n------- /o >acsparhwr I______ *> Avtraft veofcty < a) (( heart, team. Rat aRf rt^antafts wort fomiMd n addition (a wafts. |iw nnaaM aarkat vama par day. ottt ar i 11. Vas wiann iwoiem artcar. direct*. uarMr, ar a 19 Ra0Mt. tani ar wf 21. Pan 4 naesitne ^icn aslant accarsof . ?H Kwdaf l `nano. taat. iwctnai. tfm, cc.). 22. iai narw pit uiaty appianca ar ratRhrt povRad. (I) las it ia ioa at faaa>. 1 21 *"**>`irinwmMt,Minm`' Haa -bgttgY ma*gr"~anet"expubed- to asbestos 2 24 -- l-ltr "AW M-- mat1 W wria _ -- _ -- -- ---- S g-inr-w wnrVing for DOW^.-------------------------------------------------------------------------------------------------- --- S' ') yi.nKiMnn^yiMUn. - ___ __________________________ --_ - ?( D*vn:y nw i.iuiy V tiMty m etun M Xicat On ptrt at MOy iflKIrt . Asbestos is 2 27 Prcortit at eitaOiiity . ae Zo it >0. cr* rrt Naur - W A! WAI' XCii^t'gi NTL -- 30. iai Na-^ r: sdarru 4 pnyfcianilt known)- * ft: JCdless 0# NjspU! known) -- Dr, Gay~ Industrial Medicine .3. Mas mpnad laturnad R aft' - At **at wajt 1 . =er= -CtX -PO- M. **IS *C*WT- Can e< <*.* report - 7/18/75 For records , it u. fi* sate el Saath. Sijned by. r,mThe How Chemical Co. Felix Ainsworth . otto* r*. in -- n- _ OJ -- CO o_ iwniicTBiti irrmcm anion arnmacc rnun mnn nc m laatirioic irmc nil tuic cnou ST0532006 T rrom __________________ 403276 DPaTmNT OF inOuSTBIAI malIH and MEDICINE MEDICAL REPORT BlOCa no A OE^ABTMCNT supervisor on duty jOILER shop ' DOW TEL EXT MASTCM a clock NO 1 52 J 'V DATE OP ONSET Jilagnosls 6/18/75 7/-ro/ CLASSIFICATION AMBULANCE REASON FOR Cii.L OR HISTORY .as .6j'i to4il1er maker and exposed to asces tos-s i nee worxing for jc.v. RfCOMUENOATiONS TO SUPERVISOR ATTENOJNG PHYSICIAN AND OR NURSE to RETURN i1 NECESSARY _____________ O > PI INSURANCE DEPT. COPY ,__; INDUSTRIAL [T INSURANCE decision 0 PERSONAL {/> o cn co ro "O 403277 Paul M. Sttvini, M.D. Cliitf, Pulmonary Section The Methodist Hospi tad 6516 Bartnac 8oulvard Houston, Texas 7702 TEXAS MXDICAL CXKTXA Ml Teo Bowlk President Ms. Tom Foukqvuam Executive Vice President June 6, 1975 Am Coe 713-790-20' ____Cobi METHHQi W. H. Sears, M.D. 106 N. Parking Place Lake Jackson, Texas 77566 RE: Dear Dr. Sears: Thank you so much for referring this very pleasant gentleman, whose problem was that of progressive dyspnea, associated with diffuse radiographic pulmonary infiltration in volving primarily both lower lobes and pleura. You had been taking care of this patient primarily because of an intercurrent respiratory tract infection but the patient felt that progression of symptomatology perhaps signified an underlying, progressive dysfunction of unknown etiology. On admission, questioning revealed that he had worked with Dow Chemical for many years and been exposed to a variety of irritating gases but, in addi tion, had been involved in handling sheets of asbestos and been present in the environ ment when these had been handled and considerable amounts of asbestos dust was in the air. This exposure has been off and on for the past twenty to thirty years. In addi tion, he is a moderately heavy smoker and had complained of relatively recent increase in the amount of cough and sputum production. As you pointed out in your woric-up, some respiratory dysfunction was present as long as thirteen years ago, at which time he was evaluated both at St. Joseph's Hospital and M. D. Anderson, with removal of several hundred cc's of serosanguineous pleural effusion but no definite evidence of malignancy. No tissue-diagnosis was made at this time but the possibility of tumor was excluded for the patient. c/> -- CD cn co ro GO Physical examination at this time revealed a modestly obese, anxious, mildly dyspneic, white male in no acute distress. There were bibasilar rales and decreased breath sounds at both bases . No evidence of cor pulmonale or clubbing was present. Review of chest x-rays revealed that both in 1972 and at the present time, there were rather dense, interstitial increase in markings with slight honeycombings in both lung fields, primarily at the bases, with dense pleural thickening and some pleural calcification nti tmd ; m,"--MaTT. 23:56 403278 particularly in the left hemidiaphragm. This picture most closely resembles the distribution of asbestosis and, in order to both make the diagnosis and exclude the possibility of an underlying carcinoma, the patient underwent transnasal fiberoptic bronchoscopy. This was carried out under local anes thesia and was well tolerated by the patient and revealed essentially clear airways with no evidence of interbnonchial lesions. Slight bronchospasm and mucosal erythema was noted. A transbronchial lung biopsy was performed under fluoroscopy and tissue ob tained from several subsegments of the right lower lobe all showed interstitial fibrosis. In addition, an alveolar lavage was obtained and cytological examination of the ceils revealed multiple ferruginous bodies, diagnostic of asbestos. No positive cytologies were obtained. Pulmonary function studies, a copy of which is enclosed, revealed the presence of combined modestly severe restrictive ventilatory defect, with the superimposed presence of mild airway obstruction that does not seem to respond to bronchodilators . The remainder of the work-up was basically non-revealing. Under these circumstances, 1 would feel fairly certain of the basic diagnosis of asbestosis with both pleural and interstitial fibrosis . In addition, there is some superimposed airway disease, probably related to cigarette smoking, that does not seem to be particularly re versible with bronchodilators . The extent of pulmonary dysfunction more than adequately accounts for the patient's symptomatology. He is therefore entitled to some amount of disability and/or compensation. I have made aware of his diagnosis and extent of disability. I suggested to him that, although there is very little directed therapy to reverse the underlying disease process, he should avoid environmental pollutants, stop smoking and continue to remain as active as possible with exercise up to tolerance, and a certain amount of weight re duction. He will be returning to your care and has requested me to give him a copy of the letter I am sending to you. Thank you very much again for allowing me to help you with this very interesting patient. ST053 20 Of PMS/ej cc: Paul M. Stevens, M.D. Professor of Medicine Baylor College of Medicine 403279