Document DvZvp1zOg0XgpKaKM46Xn2bOQ

1 IN THE CIRCUIT COURT TWENTIETH JUDICIAL CIRCUIT OF ILLINOIS 2 ST. CLAIR COUNTY 3 FRANCES E. KEMNER, et. al. ) ) 4 Plaintiffs, ) ) 5 VS. ) NO: 80-L-970 ) 6 MONSANTO COMPANY, ) ) 7 Defendant ) 8 9 10 REPORT OF PROCEEDINGS 11 Before the HON. RICHARD P. GOLDENHERSH 12 JURY TRIAL 13 February 13, 1986 14 15 APPEARANCES: 16 Mr. Rex Carr Mr. Jerome Seigfreid 17 On Behalf of the Plaintiffs; 18 Mr. Kenneth Heineman Mr. Joseph Nassif 19 On Behalf of the Defendant. 20 21 22 23 Debra M. Musielak, CSR, CM 24 Official Court Reporter 1 INDEX 2 EASE 3 MOTION ....................................... 2 4 WITNESSES CALLED ON BEHALF OF THE DEFENDANT: 5 1. RAYMOND SUSKIND Direct Examination .................. 6 6 M O T I O N ........................................ 113 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 / 1 exhibits Page Page 2 Identified Admitted 3 EXHIBITS SUBMITTED ON BEHALF OF THE DEFENDANT 4 Defendant's Exhibit No,: 62 71 5 1694 9 1700 (1950 report) 10 , ,, .. 22 6 1701 (1953 report) 25 48 1702 (5/16 letter to retirees)8 3 ........ 84 7 1703 (5/16 letterto employees)84 . ,, ,, 87 1704 (29-page form).......... 9 8 ......... 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 BE IT REMEMBERED, that on the 13th day of November, 2 1986, the same being one of the regular judicial days of said 3 court, the above-styled cause came on regularly for hearing 4 before the HONORABLE RICHARD P. GOLDENHERSH, one of the 5 Judges at the St. Clair County Building, 10 Public Square, in 6 the City of Belleville, County of St. Clair, State of 7 Illinois. Whereupon the following proceedings were hads 8 COURT CONVENED: 9 (The following proceedings were had in Chambers, outside the 10 presence of the jury.) 11 MR. NASSIF: Judge, you sustained Mr. Carr's motion 12 regarding the suspension of trial on the 20th and 21st so Dr. 13 Suskind could attend a Lawrence Livermore Conference and 14 asked that that be -- you commented that you would maintain 15 that sustaining of that motion until we got back to you with 16 some additional information. 17 THE COURT: No, I said on the basis of what I'd 18 been told and what I had -- on the basis of that information 19 I was ruling, I was sustaining the objection. 20 MR. NASSIF: I have some more information we'd like 21 to tell the Court. 22 THE COURT: Fine. I'd like to hear it. 23 MR. NASSIF: The Lawrence Livermore problem is a 24 very serious skin melanoma that they have -- which is 2 1 potentially life threatening, not -- 2 THE COURT: I know melanoma is, and you told rne 3 that in the original argument, 4 MR. NASSIF: Okay. What they have done, they 5 initiated their first meeting was in August of '85. They 6 began preparing a protocol for an investigation as to what 7 the disease agent is out there. Dr. Suskind is the only 8 occupational environmental investigator on the committee, and 9 they do weapons research out there, and the Defense 10 Department is very interested in determining what is going on 11 with the employees, and this meeting is to plan for the next 12 six months, they met in August, they are meeting in February, 13 is to plan for the next six months' investigation to define 14 what they are going to do to the next meeting, the next 15 protocol is reviewed. 16 Dr. Suskind advised us at the time that we asked to 17 postpone his testimony from October, November, because of the 18 delay in the trial due to Mrs. Melton's injury, or illness, 19 advised us that he had to make this meeting, and we committed 20 to him that he could make this meeting. 21 THE COURT: Well, let me tell you what the problem 22 is with your entire position. You've come in here -- here is 23 the problem. You've come in here with a witness who 24 obviously you consider important. You've gone to some great 3 1 lengths to get him here. And, you say now he's available 2 these days, these days, he has to be gone these two days, 3 he's available three more days, then he has to be gone three 4 more days, then he's available two days, or something like 5 this, and then he's gone. Period. 6 MR. NASSIPs We have gotten some additional days 7 from him -- 8 THE COURT: Wait a second. In breaking everything 9 up, number one -- and, see, every other witness that's been 10 put on in this trial, even if they have had to be 11 interrupted, and some of yours have and some of the 12 Plaintiffs' have, have been here on a commitment that they 13 are going to start here and they are going to finish here. 14 Dr. Dost left for whatever he had to do with the legislature 15 out in Oregon. He came back. He stayed until he finished. 16 Dr. Carnow went up for something up in Chicago, I don't 17 remember exactly what it was, and something in Washington, he 18 came back and both times he stayed until he finished. 19 You are basically telling me with this witness that 20 we are going to have him here for X amount of days. We are 21 going to break it up with the equivalent of a week's worth of 22 recess, and then he's not going to be here any more, and that 23 is completely unacceptable. It is an arrogant position to 24 take. You are here to continue this trial. When you start a 4 1 witness you have to make the commitment to finish that 2 witness whether that witness is going to take three days, 3 which is a rarety in this case, or 30 days. And that is not 4 acceptable to me. That is absolutely not acceptable. That 5 is not -- you don't put together a trial and the presentation 6 of evidence in this trial like a jigsaw puzzle. You put it 7 together with a commitment to finish what you start, put it 8 together with a logical sequence of organization and not 9 busting things up five different times. You do it in a 10 manner that is professional like that and that encourages the 11 understanding by the jury of what is being presented. 12 What you've presented to me is saying basically by 13 the good graces of this witness, he's going to be available 14 for X amount of days, broken up like this, and you've got to 15 accommodate to it, and that is not the way a trial is going 16 to be run. That is not the way that evidence is put before a 17 jury in the truth-seeking process. That is not the logical 18 and reasonable way to run the trial. It runs counter to any 19 experienced way to run the trial, runs counter to the 20 admonitions of the Appellate Court in Lowe in the logical and 21 systematic presentation of the evidence in this trial. And 22 I'm not going to allow it. 23 Now, we have everybody here. If you want to 24 continue this discussion, we can continue it later. But, the 5 1 knock on the door by the Bailiff indicated that all the 2 jurors are here and we are going to resume testimony at this 3 time. 4 MR, NASSIF: We'd like to continue the discussion. 5 THE COURT: Fine. I'll allow you to continue it 6 after court. 7 MR. NASSIF: Tonight. 8 THE COURT: Tonight. 9 MR. NASSIF: Fine. Thank you. 10 (The following proceedings were had in open court.) 11 THE COURT: Good morning. 12 13 RAYMOND SUSKIND 14 (being called as a witness on behalf of the Defendant, having 15 been previously sworn, having resumed the stand, continued to 16 testify as follows) 17 DIRECT EXAMINATION 18 BY MR. KENNETH HEINEMAN 19 Q. Dr. Suskind, when we recessed Monday, we were 20 discussing the 1949 report with respect to the examinations 21 you did at that time, sir. And, in connection with that 22 examination, could you tell us what the laboratory test 23 results showed on these four individuals? 24 A. Laboratory tests on the four patients who were 6 1 hospitalised in Cincinnati demonstrated that with respect to 2 their blood counts and blood cells, they were all normal, 3 MR, CARR: Your Honor, is that in an exhibit. 4 Counsel, that he's reading from? 5 MR. HEINEMAN: Oh, yes? 6 A. 1694. 7 MR. CARR: Thank you. 8 THE COURT: Go ahead. 9 Q. (by Mr. Heineman) Go ahead, sir. 10 A. May I proceed? The findings on urinalysis were 11 essentially normal. Insofar as the blood chemistry analyses 12 were concerned, we found that in at least three out of the 13 four there were elevated total blood lipids or total blood 14 fat. We did not find any abnormalities in their bilirubin or 15 BUN, which is an analysis which reflects kidney function or 16 elevation in blood sugar. We did find, however, that they 17 had a decrease in prothrombin concentration. Prothrombin is 18 a factor in the blood which reflects liver function and in 19 this instance, the prothrombin time was markedly decreased 20 reflecting an alteration in liver function which we suspected 21 because of the fact that two out of the four, and possibly 22 even three out of the four we examined had enlarged tender 23 livers. 24 Their basal metabolic rates were essentially within 7 1 normal limits. We did notice that their urinary excretion of 2 organic sulfates, inorganic sulfates as well were elevated 3 and that simply reflected a -- the fact that they were 4 detoxifying phenolic components. 5 Q. Thank you, sir. With respect to the summary of 6 what you found on these four people, what were the -- how 7 would you summarize the acute condition of these men? 8 A. Well, it was our opinion that these men were 9 suffering from an intoxication characterized by chloracne, 10 skin lesions, disturbed liver function or hepatitis and 11 disturbed lipid metabolism as well as a peripheral 12 neuropathy, and we also thought at the time because of their 13 -- the complaints of irritability and nervousness, that there 14 might be a central nervous system involvement as well. 15 Q. And, Doctor, their hospitalizations, sir, how did 16 their conditions progress? 17 A. Their skin condition improved significantly during 18 their hospitalization with treatment to their skin as well as 19 vitamins and diet. And we felt that this improvement would 20 be expected to continue under good hygienic care, and if they 21 were kept free of any irritant chemical atmospheres. 22 Q. And, with respect to the symptoms that they had, 23 was there any change in those while they were in the 24 hospital? 8 1 A. Yes, there was* As a matter of fact/ their 2 neuritis in the case of all of them improved significantly* 3 Q. Now, with respect to these four menr did you at 4 that time have a prognosis as to their conditions? 5 A. Well/ we felt that because they improved so 6 significantly during their hospitalization/ that the 7 prognosis was extremely good/ and if they weref if they 8 received adequate therapy as well as remaining free from any 9 chemical insult from there on* 10 HR. HEINEMAN: Your Honor/ at this time we would 11 move admission of Defendant's Exhibit 1694, which I believe 12 was marked and identified by the witness on Monday* 13 MR. CARR: Vie have no objection to itf Your Honor. 14 THE COURT: It's admitted without objection. 15 Q. (by Mr. Heineman) Now, Dr. Suskind, did you have 16 occasion to do any follow-up with respect to these 17 individuals? 18 A. Yes, we did. 19 Q. And, I'm sorryf when did that occur? 20 A. About six months afterwards, in April of 1950. 21 Q. All right, sir. i If I may get this marked. Let you 22 hand you, sir, what's been marked as Defendant's Exhibit No. 23 1700. 24 MR. CARR: Thank you. 9 1 Q, And ask you to examine that and identify it for usr 2 please* 3 A* This is a replica of Dr. Ash and my report of the 4 examination which we performed on six individuals at Nitro on 5 April 14th/ 1950. 6 Q. Andf sirf at the time of,that examination/ could 7 you tell us how that came about? 8 A* Well/ the examination had been essentially planned 9 forf and we felt that it would be a good idea to examine the 10 same people again to see what their progress wasf and in 11 addition to look at the plant operation/ the environment in 12 which this problem had -- from which the problem had 13 originated. So that we did visit the plant as well as 14 examine these people. 15 Q. So this examination -- excuse me. This examination 16 was conducted at the Nitro plant? 17 A. It was conducted at the Nitro plant. 18 Q. All right? sir. Would you tell us, please/ what 19 you did on that occasion? 20 A. Well, we examined clinically the four individuals 21 who we had hospitalized at the Holmes Hospital in Cincinnati 22 in October of 1949/ and we also examined two additional 23 persons at the request of Monsanto who were also -- had been 24 exposed tc the products of the runaway reaction in March of 10 II i 1 1949. 2 Q. And what did you find, sir, when you conducted this , 3 investigation? 4 A. Well, if I may go over some of the individual 5 findings to demonstrate what we found, the pipefitter and 6 mechanic, Mr. McClanahan indicated that he was feeling very 7 much improved. He gained 20 pounds and was back at work 3 actually and the pains in the legs and the.other muscle areas 9 had subsided and he felt that he was in good physical 10 condition. His loss of libido, or his decreased libido had 11 disappeared and his marital sex life, he indicated, was 12 normal. He expressed some concern that the symptoms and the 13 problem might return, but we assured him that if he was 14 improving he would would probably continue to improve. 15 And we did find on physical examination that his 16 skin was markedly improved. He was probably, as we have 17 demonstrated, he was probably the most severely affected of 18 the four with respect to chloracne. And, his skin condition 19 had improved markedly. There were a few cysts and comedones 20 on the face and ears, but, there was a noteable decrease of 21 all the lesions on the back. And over the rest of the body 22 such as the upper extremities and the buttocks where there 23 were numerous lesions before, he had only a fev; 24 hyperpigmented residuals or scars, really, of the former n 1 lesions 2 We did find, however, that he had -- his liver was 3 still palpable and slightly tender. And, in summary, on 4 physical examination of this man, we felt he was markedly 5 improved and his prognosis was excellent. 6 The chief chemical operator, Mr. Willard had 7 attempted to go back to work, but, he indicated that his acne 8 flared so he quit the job and he hadn't worked since November 9 of the previous year. He did admit, however, and on 10 examination we did find his skin was very much improved, his 11 face was almost completely healed, and there was considerable 12 decrease in lesions on his neck and back although he did have 13 some lesions on the abdomen and the buttocks. He indicated 14 that he didn't have any recurrence or any pains in the legs 15 which he had previously complained about, but he gets an 16 occasional aching in the right calf, but no other 17 discomfort. 18 He did complain of some discomfort in his chest, 19 and, some substernal aching, which usually he said came on 20 exertion. 21 He, too, also gained weight since the last 22 examination. He gained about eight pounds. 23 He admitted quite freely to us -- admitted quite 24 freely to us that he didn't want to return to work and he was 12 1 avoiding work as long as he could. There was unpleasantness 2 at home. He refused to do any other work because he was 3 afraid that somebody might see him. And he indicated he 4 spent most of his time in bed or in the pool hall. 5 Did complain of some burning sensation in the eyes 6 and he visited his doctor for that once or twice a week. He 7 complained of a cough and also occasional attacks of asthma, 8 which was not verified. 9 On examination, again, we found marked improvement 10 on his face and cheek. They were healed, except for a very 11 few cysts and an occasional nodule. His liver, however, was 12 still palpable, but not tender. And we felt that this man 13 also, like Mr. McClanahan, had improved markedly and that he 14 was essentially prolonging his disability unduly and we felt 15 he was capable of returning to work as was Mr. McClanahan. 16 Mr. Steele did not return to work since that 17 initial examination and he continued to have soreness in his 18 -- on his right side. And, pains, especially on walking. He 19 also claimed that continuous standing resulted in aching and 20 in the muscles in the lower leg. He complained of soreness 21 in his eyes, but there were no symptoms referable to 22 cardiovascular or urinary, genitourinary systems. He also 23 indicated that his sex life had actually returned to normal. 24 Also that the pains in the shoulder and the nervousness and 13 1 loss of sleep, insomnia, had persisted until the end of 2 March, but was at that time when we examined him was no 3 longer present. 4 This man, however, had admitted to doing occasional 5 jobs outside of the plant, and he apparently could tolerate 6 these jobs. 7 On examination we also found that he was improved, 8 and there were very few residual cysts on his face. This was 9 Mr. Steele, and you see here he had a very large number of 10 comedones and cysts on his face and by April of the following 11 year, six months afterwards, with good treatment, these had 12 healed. So that is the chloracne had improved 13 significantly. 14 He had an erythematous rash involving the 15 follicules on the shoulder and the upper arms and there were 16 a few cysts and nodules on the back and the neck and the 17 genitalia. 18 Q. Excuse me, sir, what is an erythematous rash? 19 A, It's redness. I'm sorry. It's a red rash. We 20 felt that this man's symptom complex, his chloracne as well 21 as his other symptoms were subsiding, except that he still 22 had evidence of liver dysfunction, at least by physical 23 examination. But, we didn't see why Mr. Steele could not 24 return to work with the amount of physical improvement that 14 1 he had made 2 The last of the four was Mr. Hurley, who returned 3 to work in March of that year, as an assistant operator and 4 he also indicated that his condition, both skin and systemic 5 complaints had improved. The face lesions and the lesions on 6 the trunk had cleared almost completely, except he complained 7 of swelling of the eyelids. He also noticed that his 8 nervousness, which he complained about previously, had 9 subsided and he had complained, as you may remember 10 originally of pains in the lower legs and he was the man who 11 did the biopsy on and found some peripheral nerve 12 abnormalities. And he indicated, however, that the pains in 13 his legs and feet had improved. However, they do occur after 14 a day's work. He's being treated, or he v/as being treated 15 for his eyelid swelling. 16 He indicated that he might have some shortness of 17 breath, but this improved in the last month before we 18 examined him, and he also told us that his appetite was very 19 good, and he had no problems with his gastrointestinal tract 20 or his urinary tract. And on physical examination these 21 things were borne out. His skin was much improved. And, 22 there were a few active nodules in the groin, and on the 23 thigh, and we did notice the redness and swelling around his 24 eyes 15 1 Vie were not able to detect any liver enlargement on 2 the examination in this man. So that in his case as well/ we 3 felt that the symptom complex/ skin and systemic 4 manifestations were subsiding. The peripheral neuropathy/ 5 that is the pains still persisted/ but at a much lower order/ 6 and he did have some swelling of the eyelids. However/ we 7 felt/ toof that his prognosis was good. 8 The two others we examined/ one was a head operator 9 in that building where the accident was, and not -- had not 10 been seen by us before, and he returned to the building on 11 the evening of that accident in order to clean out that 12 autoclave where the trichlorophenol was being made and he did 13 that with caustic and water. And he found that about four 14 days later, he thought he saw cysts and comedones all over 15 the face and body, not sure this was accurate, because it's a 16 little short for the development of chloracne. Usually takes 17 longer than that to develop chloracne, but this is what he 18 believed occurred. He was given a leave for one week, while 19 the building was being cleaned up, then returned to work and 20 then within a month because of his skin condition he was sent 21 off work and he remained off for about four months. And 22 during that time, during the time he remained off work, he 23 developed peripheral neuritis and pains in the ankles and 24 legs and shoulders. And he then returned to work and worked 16 1 for about five months after that, developed a severe 2 conjunctivitis, and had not worked since January of 1950, or 3 didn't work since January of 1950* 4 He'd been treated with x-ray following the 5 observance of the skin lesions and after he was treated with 6 the x-ray, his skin became pigmented* His skin became 7 greyish brown, and remained that way for about a year, after 8 which it lightened up. He was really terribly concerned 9 about that hyperpigmentation and because of it, he became a 10 little bit of a recluse and he gave up his social activities 11 and his athletic functions and he remained in the house and 12 when we saw him, he did have a deep greyish brown 13 pigmentation of the skin and face, which we will believe was 14 the result of not just the exposure to the chemical agent, 15 but also the exposure to x-ray and perhaps even sunlight. 16 His summary, his symptoms included a 17 conjunctivitis, or a problem with his eyelids and severe 18 pigmentation. Did complain about loss of libido and 19 impotence for six months. And, he also indicated that there 20 was some shortness of breath. 21 When we interviewed him, we felt that this rather 22 handsome man had an emotional problem which was related 23 probably to the fact that he was concerned about his skin and 24 his illness. And we examined him, as I say, we did find that 17 1 he had a greyish brown pigmentation of the skin, limited to 2 the face and the neck where he was treated and there were 3 some cysts on the face and the forehead, but they weren't 4 red. And, he had a rather interesting -- I think I mentioned 5 that chloracne does produce a thickening of the skin in some 6 people. So that if you rub your hands over the skin, it 7 feels like sandpaper. The follicles, hair follicles become 8 spiny and that's called phrynoderma, which I believe we use , 9 in our report. And this man had characteristics of that 10 thickening of the skin as well as the chloracne. This spiny 11 lesions on the skin we call follicular hyperkeratosis or the 12 thickening of the keratin layer around the hair follicles. 13 And he had that not only on his face, but he had it elsewhere 14 in the exposed skin. We found that his liver was palpable. 15 And the rest of his examination was within normal 16 limits. We felt that he demonstrated the symptom complex 17 which the others had exhibited, except that he needed 18 additional time and treatment for improvement. And we made 19 some recommendations with respect to treatment of this 20 person, which hopefully was carried out. 21 The fifth individual or the second individual v/e 22 did not see previously was a man named Lane. He was a 23 pipefitter, and he developed his acne, he claimed, started 24 about two weeks after the accident. And, it started around 18 1 the face and the lips and spread to the neck. And later the 2 shoulders became involved and other areas of the body. 3 Thirty days after that, after the onset of his 4 chloracne, he developed peripheral neuritis, pains in the 5 legs and the knees and calves and heels and he -- it became 6 so severe that he was unable to work. And he also complained 1 of insomnia, and wheezing, and a cough which lasted for about 8 nine months. In this person, there v/as no weight loss like 9 there was among several of the first four that we saw, but, 10 he said that his appetite had remained good. He indicated, 11 however, that there was loss of sexual activity for a period 12 of about nine months, but this had improved and was normal at 13 the time that we examined him. 14 At the time of the examination he still -- he said 15 he still had some aches and pains in the legs at night and 16 nervousness. He indicated, frankly, he felt he had been ill, 17 at the onset, but improved markedly. When we examined him, 18 we also found numerous comedones or blackheads and cysts on 19 the face, neck, shoulders, upper arms and back and there were 20 a few inflamed nodules on the back like the others and some 21 thickening of the skin and hyperpigmentation about the face 22 like Mr. Young, the man I described previously. Had a mild 23 conjunctivitis when we examined 'him or involvement of the 24 lids. And, everything else appeared to be normal and we felt 19 1 that this man had the same skin problem and systemic problem 2 that the others had hadr and was also improving. Those are 3 the findings. 4 We did some laboratory studies as well. Would you 5 like me to go into them? 6 Q. Would you please. 7 A. In almost all of the -- of the persons we examined, 8 and we did a -- we did laboratory studies on three others, we 9 found that their prothrombin time was increased, indicated 10 persistence of liver dysfunction. Their flocculation results 11 were within normal limits. There was again an indication in 12 about seven of the persons on whom vie did laboratory tests 13 that their total lipids where increased. All of the other 14 laboratory parameters appeared to be within normal limits. 15 Q. In summary, Doctor, what was your diagnosis with 16 respect to these men on this occasion and your prognosis as 17 to their condition? 18 A. Well, as I indicated, with respect to the 1949 19 examination, that the people we examined were suffering from 20 an intoxication which affected there -- which affected their 21 skin, central nervous system. We felt that their complaints 22 of nervousness were an indication of it. Peripheral 23 neuritis, liver dysfunction and an effect on their sex life, 24 which might be the result of an effect on their endocrine 20 1 system. They uniformly had problems or a disturbance in 2 lipid metabolism or fat metabolism/ and of course the most 3 obvious symptoms that they had and most obvious findings were 4 the chloracne. Some of them, or few of them/ some 5 respiratory problems which was limited to dyspnea and 6 wheezing. The neurological problems were limited largely to 7 pain and weakness, but, in the case of the four that we had 8 seen previously, and the two additional ones, all of these 9 manifestations were improving significantly. And X think our 10 report reflects that in which Dr. Ash and I stated that all 11 of the patients are markedly improved, and that there are no 12 findings in any of those who were examined during our last 13 visit which contraindicates returning to their former 14 duties. 15 We did feel that the had operator, Mr. Young, 16 required some special attention because of his emotional 17 problems which were apparently related to that -- to the 18 effects of the intoxication. 19 Q. That was the man that had the severe -- 20 A. Hyperpigmentation and phrynoderma. 21 Q. Now, with respect to all six of these men, Dr. 22 Suskind, what was the first thing that happened to them? 23 What was the first condition that they got? 24 A. Well, the first thing that happened to some of 21 1 them* when they went in to clean out the building where the 2 accident occurred, was that they developed what I would 3 regard as the acute symptoms or the very acute symptoms of 4 initial exposure to trichlorophenol synthesis accident and 5 that is respiratory irritation, skin irritation, 6 gastrointestinal irritation, headache, nausea, so on, which 7 subsided as soon as they got out or subsequently to their 8 getting out. But, the first manifestation of the exposure to 9 the toxic agent which caused or was associated with the 10 symptom complex, the first manifestation was chloracne. And 11 all of them told us the same story So they got the 12 chloracne before -- 13 A Before they developed any complaints of pains and 14 aches in the skeletal muscles, or dyspnea or shortness of 15 breath, or loss of libido, changes in their sexual 16 interests. i 17 MR. HEINEMAN: Now, Your Honor, at this time we 18 would move the admission of Defendant's Exhibit 1700. 19 MR CARR: We have no objection. 20 THE COURT: It's admitted without objection. 21 Q. (by Mr. Heineman) Now, Dr. Suskind, did there come 22 an occasion for an additional examination of the people at 23 Nitro? 24 A. Yes, there was an additional examination. 22 i 1 Q. All right. And what gave rise to that examination 2 and when did it occur? 3 A. It occurred in 1953, in April of 1953. Before that 4 time, shortly before that time, we were in communication with 5 Dr. Emmett Kelly the then medical director of Monsanto. And, 6 we agreed that it would be a good idea to get into the plant 7 and examine a larger number of persons, people who had been 8 exposed to the runaway reaction in March of 1949 as well as 9 those who were just exposed to the ordinary process of making 10 2,4,5-T. People who came into the employ of Monsanto some 11 time after the accident and were working in the 12 trichlorophenol process, or people who were working in the 13 synthesis of 2,4,5-T, that is the actual making of that acid 14 and the salt of the acid, which was the final product, and 15 that was carried out in another building. So that we felt 16 that it would be an appropriate thing to find out what the 17 difference was between those who were exposed to the accident 18 material, and those who were just involved in the ordinary 19 process of making 2,4,5-T. 20 Q. And how many in all did you examine on that 21 indication, sir? 22 A. We examined 36 individuals altogether. Now, we 23 also had some other objectives. And, we wanted to determine 24 the types of exposure that resulted in the development of the 23 1 clinical symptoms# What did these people do? They were not 2 all chemical operators, they were not all maintenance 3 people# They might have been involved in hauling. They 4 might have been involved in some maintenance. And they might 5 have had combined exposures. So we thought that it would be 6 a good idea to find out just what kinds of work they did. In 7 occupational medicine, that's an essential aspect of 8 determining why things occur and under what circumstances 9 they occur# Go into the plant and you look at the operations 10 as well as finding out from individuals what specifically 11 they were involved in from the beginning of their 12 employment. And, at the time also we felt that it was, it 13 would be appropriate to do a hygienic survey of the two 14 buildings where the manufacturing process was going on. We 15 knew that Monsanto had their own hygienists and their own 16 engineers to look into these matters, but we felt that it 17 would be a reasonably good idea for us to do it. And, we 18 certainly had the expertise and the qualifications, so that 19 two qualified chemical engineers went in and did a hygienic 20 survey of the two buildings. And, the purpose of their visit 21 was to find out what the conditions of the environment were 22 and to recommend possible alterations which may be made to 23 improve the hygienic conditions. 24 Q. Mow, on the occasion of this particular incident, 24 1 did you prepare a report on that as well? 2 A. Yes, we did. 3 Q. Let me hand you, sir, what's been marked as 4 Defendant's Exhibit 1701 and ask you to examine that and 5 identify it for me, please. 6 A. This appears to be a replica, exact replica of the 7 report which was submitted on a clinical and environmental 8 survey of the Monsanto Chemical Company plant in Nitro, 9 West Virginia, which a report which we carried out in April 10 of 1953. 11 Q. All right, sir. Now, could you tell us with 12 respect to the 36 people that you saw, how many had been 13 exposed to the autoclave accident and how many were involved 14 in the production? 15 A, Well, in this group, there were ten individuals who 16 were exposed to the autoclave incident. And, the rest of the 17 group of 36 were exposed to the, either the regular 18 operations in Building 51, in which trichlorophenol was 19 manufactured, a small number in that operation, and twelve 20 were involved in the regular operations of making 2,4,5-T 21 itself. And there were a few in hauling and several in 22 maintenance, and there were about five who had combined 23 exposures of different -- in different buildings, but most of 24 them, most of these exposures had to do v/ith the making of 25 / \ 1 2,4,5-T, so that essentially there were ten from the accident 2 and 26 from the regular operation of making 2,4,5-T. 3 Q. Now, when you conducted your examination of these 4 people, what was the scope of what you did? 5 A. Well, we did a -- we believed to be a thorough 6 clinical examination of all of the 36, and we did laboratory 7 studies on selected people, people that we felt were severe 8 and we were very interested to know what their laboratory 9 status was. On those individuals we did urinalysis and 10 hemograms, that is blood studies, and we did some more, for 11 instance, and prothrombin time and lipids and some liver 12 function tests as other liver function tests as well, 13 Q Now, with respect -- 14 A, Vie only did those if the severity of the findings 15 appeared to justify them, 16 Q. Now, what was the -- would you summarize for us, 17 please, the symptoms that were presented by this group that 18 you saw in 1953? 19 A. Well, I think it would be useful to separate the 20 persons who were exposed to the accident material from the 21 rest of that group. The ten individuals who were exposed to 22 the accident material, all of them gave histories of fairly 23 severe chloracne in the beginning. In the beginning. And, 24 among them, most of them diia have other systemic 26 1 manifestations following the appearance of the chloracne. 2 Those who were not involved in the accident, the other 26, 3 first of all, their chloracne in general was not as severe, 4 historically or on examination than the -- those who were 5 involved in the accident, and their systemic manifestations 6 if they were indeed present, we felt were of a much lower 7 order than those involved in the runaway reaction. 8 Actually, we found that all of the -- and they were 9 chosen on that basis, all of the people who had chloracne 10 were put into that group to be examined. There was one 11 individual, however, who we felt did not have chloracne, 12 although he did complain, he had a folliculitis, which is 13 common in the workplace, it's an infection of hair follicle 14 on the back, but his, skin was essentially negative. But, he 15 complained that he had aches and pains and when we really got 16 to talk with him, he sounded like a complainer. That was a 17 Mr Kyle 18 Q. When you say a folliculitis, what is that? 19 A. It's an inflamation of the hair follicles and it 20 occurs in machinists. It occurs in persons of restricted 21 hygiene, who don't bathe frequently or frequently enough so 22 that their -- the soilage on their clothes is a factor in the 23 follicular infections, infections of the hair follicle, and 24 that is seen very commonly in industrial populations. 27 I >1 Q. Now, with respect to the symptoms that were 1 2i presented, sir, these were -- were these by history? i 3 A. Yes, each individual was interviewed and they were 4 interviewed by physicians, and the physicians who interviewed 5i them were myself and Dr. Davis, who was a board certified 6 occupational physician having been trained at the University 7 of Cincinnati and a Robert Akin, who was a dermatologist, and \ we interviewed all of these people. Dr. Ash was not involved in this study. Q. All right. And, how did these symptoms presented 11 by history, relate to the symptoms that you had previously ) 11 received from the people on other examinations? 13 A. Well, they were all very similar. They were all U very similar, except for severity, and it was our opinion 15 that there was significant difference between the severity of 16 the onset of the symptoms as well as the -- as the severity 17 of the skin problem as well as the systemic manifestations ia between, that is, there was a real difference between those 19 who were exposed to the accident and those who were just 20 involved in the making of 2,4,5-T. 21 Q. And to what did you attribute that difference in 22 the severity of symptoms? 23 A. We assumed, and I think it was a correct 24 assumption, that the difference was due to the fact that 28 1 there was an acnegenic and hepatotoxic agent, that is a liver 2 toxin, in the trichlorophenol accident, which was probably of 3 a greater concentration than the -- than in the making of 4 2,4,5-T, It was something in the trichlorophenol which maybe 5 eventually got into the 2,4,5-T and it probably did, because 6 they also had, people working 2,4,5-T, had symptoms, but, 7 those were not as severe. So that just thinking as a 8 toxicologist, the assumption would be made that the accident 9 material -- the accident-exposed individual had a heavier 10 exposure to the toxic agent. 11 Q. All right. Now, when you actually examined those 12 people, could you give us a summary of what you found? 13 A. Well, I think the first part of this summary should 14 relate to the progress that we noted, because we had examined 15 people before, and, we felt that those people whom we had 16 seen before with moderate to severe degrees of the complexion 17 characterized by acne and pains in the extremities and liver 18 dysfunction and dyspnea, nervousness, all of those people had 19 improved markedly. All of those that we had an opportunity 20 to reexamine. And we had an opportunity to reexamine all but 21 one. 22 Q. Now, had they improved from what you had seen in 23 1950? 24 A. And it was quite obvious that all of them had 29 1 improved significantly. 2 Q. From even what you had seen in 1950? 3 A. Absolutely. 4 Q. Okay. 5 A. And, like me to give you individual instances, I 6 can, but I think that, for example, Mr. Hurley was markedly 7 improved from even 1950. He still had some sensory loss in 8 the feet, but all of his other manifestations, all of his 9 other manifestations, the chloracne and everything else had 10 subsided. 11 In the case of Harold Young, the individual who was 12 -- had this pigment problem, which he complained about and 13 the behavioral problem, as well as a rather severe case of 14 chloracne, he had some residual lesions, just a few, but he 15 was vigorous and energetic, and he held down full time on the 16 plant, not only had a full-time job in the plant, but also 17 operated a private business with his new wife in his off 18 hours and weekends. He went into the drive-in restaurant 19 business. But, he was really doing extremely well. 20 Mr. Willard at that time in 1953, physically was 21 remarkably improved. But, he was complaining about cardiac 22 palpitations and was worried about his heart, and one of the 23 physicians indicated that he had a heart problem and there 24 was no evidence from our examination that he did have a heart 30 1 problem, v/e believed, and it's in the record that he was an 2 unstable individual who made a very important psychological 3 adjustment, and there was a serious possibility that his 4 heart disease was iatrogenic, that is he didn't have a heart 5; disease but the doctor made a diagnosis of one and that does 6 happen 7 Q. I'm not sure I understand what iatrogenic means, 8 A, Iatrogenic means physician originated. 9 Q. Okay. 10 A. For example, if a physician prescribed a drug which 11 produced an adverse reaction in the individual, this would be 12 iatrogenic, the adverse reaction would be iatrogenic. 13 Q. Nov/, but you had examined -- this was Mr. Willard? 14 A. Mr. Willard, right. 15 Q. And in the opinion of the physicians in your group 16 that examined him, did he have any signs of any 17 cardiovascular problem? 18 A. There was no signs on our examination of any 19 cardiovascular problem. 20 Q. Now, with respect to the, I'm sorry, did we cover 21 the four people? 22 A. We didn't reexamine Mr. McClanahan. 23 Q. I'm sorry, did you say you did not? 24 A. No. No, he was not -- he was not available. 31 1 Q. With respect to all of the people from the 1949 and 2 1950 examinations, whom you saw again in 1953, what was the 3 status of their health in 1953? 4 A. Well, as I have indicated already, they were all 5 markedly improved, and even Mr. Willard who still complained 6 a good deal, when we examined him, we couldn't find anything 7 wrong with him except for some very few mild residuals of 3 chloracne. 9 Q. Now, with respect to those in addition to those 10 whom you had seen before, what -- can you give us in summary 11 form, what you found with respect to those people? 12 A. Well, again, I indicated that those who were 13 involved in the -- in the process accident, they all 14 developed chloracne. And some of them did have the systemic 15 manifestations which we found in the first four. The 16 individuals who were not exposed to the process accident, but 17 just to the normal operation of making 2,4,5-T, they had some 18 chloracne, but the complaints were never as severe as a whole 19 as those who were involved in the process accident, nor were 20 there systemic manifestations. Some of them did not have 21 systemic manifestations. 22 Q. And with respect to the liver dysfunctions that you 23 had discussed on earlier examinations, did you find any liver 24 dysfunctions in this group that you saw in 1953? 32 1 A. Those that we did laboratory studies on, we did not 2 find any abnormalities. 3 Q. I see. 4 THE COURT: Is this a good point for a short 5 break? 6 MR. HEINEMAN: Yes, sir. 7 THE COURT: We will take a short recess at this 8 time and then we will resume testimony. I would remind you, 9 you are not to discuss this matter among yourselves, with 10 anyone outside the jury panel or as of yet form any opinions 11 or conclusions about the matters on trial. Court is in a 12 short recess. 13 (Following a recess, these proceedings were had in open 14 court.) 15 THE COURT: Go ahead. 16 Q. (by Mr. Heineman) Dr. Suskind, did there, 17 following the 1953 examination that you conducted at Nitro, 18 West Virginia plant, did there come a time when there was a 19 mortality study done on that Nitro population in which you 20 participated? 21 A. Yes. 22 Q. All right. Can you describe for the Court and the 23 jury the events which triggered or brought about that 24 mortality study? 33 1 A. Yes. There were a series of events and I think 2 it's appropriate to recount them. Events which led to the 3 alerting of the scientific community and the community as a 4 whole. Alerting them to the importance of studying, studying 5 populations which had been exposed to, and by that time 6 starting in 1957, we knew that the toxic agent, or the most 7 important toxic agent in the trichlorophenol process was 8 TCDD, 2,3,7,8-tetrachlorodibenzo-para-dioxin. This was 9 discovered literally first in Germany and then published by 10 two dermatologists from Hamburg, so that they were alerted as 11 to the fact that the acnegenic agent and the toxic agent was 12 2,3,7,8-TCDD. The Viet Nam war came to pass and Agent Orange 13 had as its two major constituents 2,4-D and 2,4,5-T and the 14 2,4,5-T was a herbicide, a defoliant which might have and did 15 contain concentrations of TCDD. 16 In 1969, the interest was reestablished largely by 17 the fact that the national government had a private 18 laboratory do a study on the teratogenicity or the birth 19 defect possibilities of TCDD in rats, in animals, and it was 20 found that TCDD in rats produced birth defects. That was 21 "69, In *68, there was an epidemic of chloracne and some 22 systemic manifestations with it, which occurred in Japan as a 23 result of accidental ingestion, eating of rice oil that was 24 contaminated with PCB's, And I'm sure you've heard a good 34 X deal about PCB's, and in this instance it was used as a heat 2 conductor in a manufacturing process making rice oil and it 3 leaked into the rice oil# and there were literally thousands 4 of persons that consumed the rice oil who were affected. 5 This was in Japan in the southern island of Kyushu and the 6 population was largely in the area around the large city in 7 Kyushu called Fukuoka, I've had an opportunity to visit that 8 area and even examine some of the people who were affected f 9 many years later. This alerted the international community 10 into becoming interested in PCB's and its contaminant and its 11 contaminant happened to be the chlorinated dibenzo-furans 12 which is related to TCDD, Which is related to TCDD, Because 13 of these incidents, the National Institute of Environmental 14 Health Sciences decided in 1973 to call a National Conference 15 of Scientists including physicians on how much did we really 16 knov; about the toxicologic effects, the environmental effects 17 and the health effects of TCDD, and the dibenzo-furans. This 18 was held in North Carolina and I believe the paper that I 19 presented there is an exhibit, and what I talked about simply 20 was my experience with the Nitro population. And what I knew 21 about the acute and the subacute effects of making 2,4,5-T in 22 which TCDD was a contaminant. It was the only clinical paper 23 given at that time there. What was apparent is that we 24 needed to have some kind of assessment of what the state of 35 1 knowledge was and we tried to do it at that meeting, and it 2 was also obvious that what really needed to be done was to do 3 a lot of work, to do a lot of scientific work, analytical 4 work, as well as toxicologic and medical work* Especially 5 with respect to the populations that were known to be 6 affected by PCB's, as well as the contaminant of 7 trichlorophenol, which is TCDD. 8 A couple of years later there was another meeting, 9 and this was also in North Carolina in Quaila Roosa, lovely 10 little place in which we were housed in a small home, and the 11 people involved were just those who were really engaged in 12 work in TCDD, toxicologic effects and environmental effects, 13 health effects* That also was a kind of a progress report 14 conference* That was 1975. 15 In 1976 there was Seveso, which was literally the 16 same kind of a runaway reaction that occurred in Nitro* 17 Exactly the same kind of runaway reaction. A kettle 18 containing trichlorophenol had an accident, and the valve 19 opened up and spewed out the material from the 20 trichlorophenol kettle into the atmosphere. The so-called 21 toxic cloud contained trichlorophenol and the contaminants 22 including TCDD. And, as soon as that happened, because 23 scientists in the United States had been working on those 24 problems, the Italians asked for help, almost right away. 36 1 And, what happened was that the Governor of Lombardia where 2 Seveso is. It's very close to the city of Milan, and 3 scientists from the area, including University of Milan and 4 the equivalent of our National Institutes of Health from Rome 5 was there, Professor Pocchiari, and they came to the State 6 Department to seek help. 7 Well, the State Department had the National Academy 8 Of Sciences bring together a group of people, including 9 myself, to meet with the -- to meet with the Italians, and we 10 did this, and one of the things that we decided to do at that 11 time was to send over at least one representative of this 12 group over to Italy to survey the problem, and we did that. 13 We selected one scientist from the group. That was 1976, 14 1978, after this had occurred, the World Health 15 Organization in conjunction with our National Institute of 16 Environmental Health Sciences called out an international 17 conference on dioxins and dibenzo-furans in Leon, and the 18 copy of the paper I gave there on what I knew, I think, is 19 also an exhibit. What was interesting about that was that 20 what we were asked to do was, is to develop some kind of 21 protocol, a plan, with a set of objectives, and what kinds of 22 populations should be studied and what kinds of analytical 23 processes needed -- analytical methods needed development. 24 And, all of the people who were there, which included persons 37 1 from all of the countries in which there were industries that 2 had problems related to trichlorophenol and TCDD, so the 3 scientists from Great Britain and Holland and Germany, Soviet 4 Union, Jirasek from the Czechoslovakia was the first time he 5 had ever been out of the country. He came to Leon to present 6 his very interesting information about the problem at Spilano 7 and he admitted that this was a very dirty plant. This was 8 the plant in which they had -- 9 MR, CARR: May we approach the bench, Your Honor? 10 THE COURT: Yes, you may, 11 (The following Side Bar conversation was had outside the 12 hearing of the jury,) 13 MR, CARR: The witness is doing that which the 14 Court has ordered he should not do. He is giving a statement 15 from a man from Spilano in which he admitted that the plant 16 was dirty. This is hearsay. It is inadmissible. Counsel 17 knows it's inadmissible and I assume he had instructed this 18 witness so that this witness knows it's inadmissible. 19 THE COURT: I think we went through this Monday. 20 MR, HElNEMAN: Right. 21 THE COURT: I told you to instruct him about that, 22 and, apparently it didn't do much good. 23 MR. HEINEMAN: I told the witness about the Court's 24 admonition with respect to statements of others being hearsay 38 1 and not admissible and that they should not be. He 2 volunteered. He understood that. 3 THE COURT: Why did he just make that statement? 4 MR. HEINEMAN: I'm sure he was just in the midst of 5 describing what happened at this meeting. It just slipped 6 out. I don't know. 7 THE COURT: Well, this is a scientific person, a 8 very intelligent person who has been at this longer than any 9 of us have been alive. I don't think things like that just 10 slip off, slip out. The next time we may have a discussion 11 about contempt if it happens again. I'm going to order the 12 jury to disregard this. 13 MR. CARR: I would prefer that you not order the 14 jury because I think that might simply emphasize the 15 statement. 16 THE COURT: Okay. Pine. 17 (The following proceedings were had in open court.) 18 Q. (by Mr. Heineman) Dr. Suskind, without describing 19 what other people said at this meeting, would you please go 20 on and describe the events that led up to the mortality 21 study? 22 A. Thank you. I understand. As a result of that 23 meeting and the events that I described previously, some of 24 us, like myself, decided that we should go back and study the 39 1 populations which had been previously exposed. At that 2 meeting we did develop a set of, and it's in the exhibit, the 3 information gaps that needed to be addressed, what kind of 4 information did we need from these populations. Well, what 5 kind of information did we need from toxicologic studies. 6 Prior to that -- prior to that, I called Monsanto in 1976, 7 and asked that we be allowed to do a study of the 3 populations, the population at Nitro that had been exposed, 9 because this was of great international interest and great 10 scientific interest, and Dr. Roush responded and indicated 11 that he would take this up with the people at Monsanto, and 12 as a result of that correspondence, we did get by 1978, when 13 even before I went to Leon, we had a mortality, the beginning 14 of a mortality study underway. That is we were attempting to 15 determine who was still alive. Vie felt that it was kind of 16 important to start with the population that had been exposed 17 that we reported to a high level of TCDD, people from the 18 runaway reaction. So we chose that population, concentrated 19 on that population, and it was a first step, a mortality 20 analysis of those people who were exposed to the accident. 21 Q. Now, Dr. Suskind, would you tell us generally, what 22 is -- what is epidemiology? 23 A. Well, I think that epidemiology is defined 24 differently by different authors, but I think that a most 40 1 general definition, which I think applies to the work that we 2 do, is the distribution of disease in human populations and 3 the factors which are associated or influence the frequency 4 of those diseases or that disease. 5 Q. How, what is it that one looks for in a study to 6 determine association? 7 A* Well, one looks for the factors, the factors that 8 may influence or determine the disease, and for example if we 9 have a population that we know to be exposed to a chemical 10 agent, and that we know or suspect that they have been 11 affected, we would like to know in a mortality analysis, at 12 least, what these people have died from as compared with 13 let's say, an unexposed population, or the general population 14 in the United States. 15 Q. The jury has heard the term statistically 16 significant. What is -- what does that term mean and how 17 does that relate to this association that you are talking 18 about? 19 A. Well, one wants to know whether or not the 20 differences between the -- let's say the exposed group, and 21 the unexposed group, is really significant. From a 22 statistical standpoint and there are ways of looking at the 23 level of significance, for example, in looking 'at deaths for 24 example, looking at deaths, one one compares the expected 41 1 frequency of death in a general population to these which one 2 has observed in the population which has been exposed. And, 3 then the probability that there is a difference has to be 4 determined. And, that might be explained just on the basis 5 of chance. So that the level of significance is really, real 6 significance is determined by the so-called P Value, the P 7 Value, and the P Value is the probability that the difference 8 between the two groups is based on chance, so that the 9 greater the P Value, the more likelihood it is chance, and 10 the smaller the P Value, the less likelihood it is due to 11 chance and the greater likelihood it is due to the factors we 12 are looking at. Such as exposure to a substance. And 13 usually the P Value which is -regarded as statistically 14 significant, not chance, but due to a -- a given factor is 15 usually a P Value below that of .05. If it's above .05, we 16 usually regard that as probably not statistically 17 significant, so that a P Value of .02 or a P Value of .01 is 18 statistically significant. 19 Q. Now, I don't want to get too complicated with this, 20 but can the P Value change or be different from one group of 21 statistics to another? Is it always the same? 22 A. Well, no, you have to look at different 23 parameters. For example, if one looks at the P Value of -- 24 let's say all causes of death in an exposed population as 42 1 compared to the general population, that could be different 2 than if you just looked at the P Value of one cause of death, 3 like lung cancer, or liver cancer. The P Value might be very 4 different. 5 Q, Nov;, does an epidemiological study establish a 6 cause and effect relationship? 7 A, An epidemiologic study attempts to do that but I 8 think what is -- what is more significant about an 9 epidemiologic study, it attempts to establish association and 10 the cause-effect -- the cause-effect aspect of it is if you 11 have a very large population, and you do a study, and there 12 is is a very obvious, very obvious relationship between an 13 exposure factor and one parameter of disease, and the P Value 14 is ,0001, it's very likely that there is some causal effect. 15 However, in most instances, one can only say that there is an 16 association, an association between the exposure, especially 17 if it's a small population, 18 Q. Now, how would you then differentiate the term 19 association from cause and effect? 20 A, Well, I think what one does say is there is, in 21 association, there is a possible causal relationship. And, 22 very often, that can be -- that can be further supported by 23 other kinds of studies, other kinds of studies where you have 24 cases of exposure, like to the toxic effects of a drug, 43 1 exposure and then effect. Exposure effect. But, if you are 2 dealing with an epidemiologic study, then you are dealing 3 with, especially a mortality analysis, then you are dealing 4 with a retrospective -- retrospective study, which means that 5 you go back and look at already existing statistics for let*s 6 say causes of death. If, for example, you were doing a study 7 of the effects of a drug, and it's possible, association with 8 risks for death, this might bervery helpful, but I think that 9 it is kind of, well not kind of, but it's also important to 10 have other kinds of data, clinical data that actually 11 demonstrate that there is a time, a quick time relationship 12 between the -- the exposure like to a drug and a toxic 13 effect 14 Q. We have heard the term confounding factors used in 15 this courtroom. I wonder if you could explain that to us. 16 What does that mean? 17 A. Well, confounding factors are factors that may also 18 influence, also influence the outcome. For example, in 19 looking at the -- a problem of an exposure being associated 20 with heart disease, one of the confounding factors in heart 21 disease is age. In the United States and most civilized 22 countries, the most common cause of death is heart disease. 23 So that if you are looking at a population and attempting to 24 determine whether or not there was a greater risk for heart 44 1 disease, you have to consider age. So age is a confounding 2 factor. Smoking is a confounding factor. Alcohol 3 consumption is a confounding factor. And in problems, for 4 example, if you are looking at neurological consequences of 5 an exposure, you have to consider the other common problems 6 that cause neurological problems, like diabetes, like 7 alcohol. 8 Q, All right. Are -- would it be fair to say the 9 confounding factors are things that cause their own health 10 effects? 11 A. Yes, I think that would -- that would be one way to 12 look at it, but, when we are looking at -- these are factors 13 for which in doing an epidemiologic study, you must make some 14 adjustment. And it's difficult to make these adjustments if 15 you are doing a retrospect and mortality analysis. 16 If you are doing a morbidity study, on the other 17 hand, you have at hand from individuals that are being 18 examined, you have information about these confounding 19 factors. 20 Q. Okay. So, you would know in a health or morbidity 21 or sickness study who smokes and how old they are and who 22 drinks and that sort of thing? 23 A. Right. 24 Q. Is that right? 45 1 A. That's true. 2 Q. If they are still alive you can ask them? 3 A, (indicates affirmatively.) 4 Q. Okay. 5 A. In some mortality studies, I know that there have 6 been attempts to find out from next of kin how much they 7 smoked, or how much alcohol they consumed. That's often very 3 difficult to do. 9 Q. All right. Now, what are the types of epidemiology 10 studies that are normally done? 11 A. Well, there are two general types. One is a 12 retrospective study, epidemiologic study, where you look back 13 and take already existing data, already existing data and 14 like in a mortality analysis, and you determine what the 15 difference is from this already existing data like death 16 certificate, or death certificate and hospital records and 17 you compare that data to the frequency of causes of death to 18 the general population. That's retrospective. 19 Then you have prospective studies, and prospective 20 studies, the largest number of them are usually morbidity 21 studies. You'll look at existing populations, and determine 22 what the state of their health is of the population and you 23 then compare an exposed group, if it's a chemical agent you 24 are interested in, to a non-exposed group, but you must have 46 1 some kind of control group. And in a morbidity study, you 2 usually don't use general population figures. You usually 3 use control groups which you examine, too. 4 Then there are case control studies and case 5 control studies are these. You take a population, for 6 example, that has -- we know has died of certain type of 7 cancer. We are interested in knowing whether or not that 8 type of cancer is related to an exposure like cancer of the 9 liver in China. Is it related to their high incidence of 10 hepatitis. Is it related to their high incidence of 11 hepatitis, and they have a very high incidence of hepatitis, 12 and what you do then is to determine if indeed this group of 13 persons v/ith cancer of the liver have had hepatitis and 14 when. And then you take another group that has no cancer of 15 the liver, a control group. Matched demographically. 16 Demographically means matched for age and socio-economic 17 factors, education, and so on. And, you find out whether or 18 not that matched group had the same frequency of hepatitis or 19 very much less. Very much less. 20 Q. All right. 21 A. That's a case controlled study. That's a different 22 kind of study. You start with the effect, people who are 23 affected. A\nd then you go back and find out if they were 24 indeed exposed to a particular kind of disease or a 47 1 particular kind of chemical or particular kind of infectious 2 agent. 3 HR. HEINEMAN3 Okay. I see it's lunchtime, Your 4 Honor. 5 THE COURT: Pine. Ladies and, gentlemen we will 6 break for lunch at this time. We will resume again, excuse 7 me, at 1:15. I would remind you that the admonishments I 8 gave you earlier will apply to this break also. Court is in 9 recess for lunch. 10 (Following a recess for the lunch hour, these proceedings 11 were had in open court.) 12 MR. HEINEMAN: Your Honor, I'm informed that I 13 neglected to move this morning the admission of Defendant's 14 Exhibit 1701, which was the 1953 report, and I'd like to do 15 so at this time. 16 MR. CARR: We have no objection. 17 THE COURT: Fine. It's admitted without 18 objection. 19 Q. (by Mr. Heineman) Dr. Suskind, this morning you 20 were talking about the Seveso incident in 1976, did there 21 come a time v/hen you yourself went to Seveso, sir? 22 A. Yes, I went to Seveso in 1982. 23 Q. 1982? 24 A. Yes. 48 1 Q. And, what did you do there, sir? 2 A* Well, I was invited to Milan to give a lecture to 3 the Carlo Erba Foundation in Milan, at the same time the 4 Lombardia office that ran the Seveso studies invited me to 5 look at and talk with the people who were involved in the 6 study* One of the experiences I had was to examine some of 7 the people who had been exposed and developed chloracne, and 3 there were three children who had been exposed in *76. And, 9 they were now adolescents and I had a chance to examine 10 them* It was an interesting experience, because on the day I 11 arrived there, the examination study was resumed* They had 12 terminated it for awhile, and there was a resumption of the 13 clinical examinations studies at the at the Provincial 14 Hospital, and I was asked to look at some of the cases* 15 Q. Okay. What did you find, sir? 16 A. Well, I found that among the adolescents that I 17 saw, one was actually a pre-adolescent and had a little bit 18 of acne vulgaris around the nose, but -- and also had minimal 19 chloracne on the skin of the cheek bones. The other was a 15 20 year old girl who had rather severe chloracne at the onset, 21 and at the time I saw her, there was a residual chloracne, 22 not severe, and she also had some indication of acne vulgaris 23 as well* 24 Q. Now, Dr. Suskind, we were talking just before the 49 1 luncheon break about certain types of studies, and you had 2 just finished, I believe, telling us about the^case control 3 type study, is that correct? 4 A. Yes, 5 Q. One of the types of studies we have heard mention 6 of is a cohort study. Could you tell us what that is, sir? 7 A. A cohort study is a study in which the 8 epidemiologist identifies sets of populations for 9 comparison. If it's a morbidity cohort study, it would 10 involve a population perhaps that was known to be exposed to 11 a certain agent, and a comparable control population which 12 was not exposed to that agent comparable perhaps 13 demographically, 14 Q. Okay. 15 A. In a mortality study, one can also use cohorts and 16 in that kind of a study one would again use a population 17 exposed and determine what the risk for causes of deaths were 18 in that study as compared with the unexposed population. 19 Now, in another type of cohort study, one can use an exposed 20 cohort, and compare the results of the analysis of the 21 mortality data to the frequency of death from the same causes 22 or the same organ system involvement as it occurs in the 23 general population. That is looking at the mortality 24 statistics of the nation. This is a very common way of doing 50 11 1 1 it. One can use the mortality statistics of the same county, 2' same state, if they are good mortality statistics, but in 3' many instances one uses the mortality statistics for the i 4: nation. 51 Q. Now, can you give me an example of a cohort 6 i, morbidity study? 7 A. Well, a good example, I suppose, is one which I 8 conducted myself using the Nitro population which was exposed 9 and compared their health status, their health status to a 10 control population which was not exposed. H; Q. We will get into that study in some detail later 12 j on, sir. Can you give us an example of a cohort mortality 13 study? 14 A. Well, a cohort mortality study would again be one 15 that I did in which we compared a cohort of persons known to 16 be exposed to, in this instance the runaway reaction material 17 from the Nitro plant in a certain period of time, with 18 certain outcomes, like chloracne. That was the identity of 19 the cohort, as compared -- and we compared their frequency of 20 deaths from 22 different causes by organ systems as compared 21 to the general population. That was a mortality cohort. 22 Q. All right, Nov;, there is one type that you have 23 not yet told us about, sir, and that's a cross sectional 24 study. Can you tell us what that is? 51 i 1 A. A cross sectional study is very simply, it's a 2 state of health study of a given population, an identifiable 3 population. Without identifying it perhaps by exposure, or 4 non-exposure, just let's say a population working in a plant, 5 v/hat's the health status of a population working in a plant 6 making solvents, perhaps. And, there are any number -- it's 7 a very simple kind of study, and what one does is after you 8 have identified some of the problems that have arisen in a 9 population like that, then you might use those parameters as 10 variables, variables that is you compare, let's say, people 11 who work with solvents in a plant, compare people with 12 dermatitis as compared with people who don't have 13 dermatitis. And see what they -- their health status of 14 those who had the dermatitis is by comparison to those who 15 didn't have the dermatitis. IS Q. Is an effort made in a cross sectional study to 17 find a not exposed group? 18 A. Well, one might, as a result of doing it, find it, 19 but you don't start out with that. Simply examine the 20 population and it might be possible to determine that, yes, 21 by history, by work records, you do determine that there is 22 an exposed group and an unexposed group, but you don't start 23 out with -- and a cohort that has that, has those 24 characteristics. ---------------------------------------------------------------- ------------------52 i, *4 < * %l} 1 Q. And# does that factor differentiate that kind of 2 study from some of the other studies you've previously 3 described? 4 A. Yes# it differentiates it from a cohort study where 5 you've already established what the exposure characteristics 6 are and maybe some of the clinical outcome characteristics 7 are* 8 Q* Can you give us an example of a cross sectional 9 study? 10 A* Well# one that comes to mind# because it's so close 11 to my interest is the cross sectional study that was done at 12 the Nitro plant by Dr* Marion Moses and her group# and they 13 simply identified# they recruited anybody who wanted to come 14 into the study# and they got a population of 226 people and 15 then they examined them thoroughly# and they found out that 16 there was a group that had at one time developed chloracne 17 and another group in that plant who didn't develop 18 chloracne* And what they did is to compare then the health 19 parameters of the chloracne group as compared with the 20 non-chloracne group. This was after they had identified a 21 chloracne group and a non-chloracne group. 22 Q. Nov/# getting back to the mortality study which you 23 were telling us about before# which you conducted at Nitro# 24 does that mortality study go by a particular name in 53 1 scientific circles? 2 A. Wellf it's a cohort study, but it is simply an 3 attempt to determine the -- the possible increased risks for 4 causes of death among an exposed population as compared to 5 the general population. The exposed population being the 6 cohort. 7 Q. Okay. Now, with respect to the mortality study 8 that you are talking about, would you tell us how that got 9 started? You already mentioned the conversations with 10 Monsanto initially in '76, but how does that get started and 11 whom did you work with on it? 12 A. Well, in 1978, we had been in communication with 13 Dr. Roush, and then following that Judy Zack, and we decided 14 that one of the places to start to determine what the 15 long-term health effects were of working with 2,4,5-T and its 16 contaminants, especially TCDD, was to do a mortality analysis 17 of those who were the most heavily exposed, and back in 1953 18 we knew that therewere at least 117 people who were 19 identified with that runav/ay reaction. And, we wanted to 20 know what happened to those people if there were indeed more 21 of them, and therewere, whether they were still alive, and 22 to do a mortality analysis of that group, the group that we 23 regarded as the most heavily exposed to manufacture of 24 2,4,5-T and especially because of the contaminant TCDD. And, 54 1 I was responsible essentially for determining what the 2 protocol was going to be, the identification of the 3 population, the kinds of records to be used, the program of 4 the analysis as well as the -- programming the data as well 5 as the analysis. Now, a very important aspect of doing that 6 kind of a study is what in epidemiology we call shoe leather 7 epidemiology. This means that the individual has to really 8 go from house to house or place to place and dig out 9 information about a population which was exposed 30 years 10 before. And, Miss Zack was the individual who did that. And 11 she got to the work records and the safety records and the 12 medical records, and the -- and the workman's compensation 13 records to see who had a medical record of chloracne, which 14 was an indicator that they had some reaction and that they 15 were involved in the accident, and 122 people were 16 identified. And then she went on to find out who died. And 17 she found out who had died of those 122, and she dug up the 18 death certificate of those people, and she was able to get 19 100 percent of the death certificates. That's somewhat 20 unusual, but this is a relatively small group, but she was 21 able to do that. And, there were, out of the 122, there were 22 32 deaths. So she got all of the 32 death certificate. 23 Q. Now, Dr. Suskind, you had -- you said that there 24 were 122 that were identified for the study, is that right? 55 1 . A Yes. 2 Q. Now, a moment ago you mentioned the figure of 117, 3 what was that in connection with? 4 A. Well, I mentioned 117 because if you look at the 5 1953 report, you'll see at that time we knew that there were 6 117 who had been exposed to the runaway reaction. But, maybe 7 they t^eren't all identified by 1953, so that when we really 8 did a more thorough examination as to who was exposed to that 9 runaway reaction, it came out to 122, not 117. 10 Q. Now, let me hand you for a moment, if I may, 11 Defendant's Exhibit 92. Can you examine that and identify it 12 for the jury, please. 13 Q. As I recall, this is a copy from the American 14 Journal of Industrial Medicine# of the health status workers 15 study that was conducted by Dr. Moses and her colleagues of 16 some of the Nitro group. This was done in 1979, I believe. 17 This is a copy of the report. 18 Q. All right. Is that the -- is that a report of the 19 study that you referred to a moment ago as being the cross 20 sectional study of Nitro? 21 A. This is a cross sectional study. 22 Q. By Moses. Now, I'd like to direct your attention 23 to Page 167. You have that, sir? 24 A. I do. 56 1 Q. There is a statement at the top of the page that I 2 want to ask you about, have to do v/ith these numbers of 3 people. Would you read aloud the second sentence from the 4 top of the page that begins, only several years later? 5 A. "Only several years later was it further determined 6 that a 111 other workers in 2,4,5-T production had chloracne 7 prior," and it's in italics, "to the 1949 explosion." And the 3 quotation is from Suskind, 1977. 9 Q. All right, sir. Now, I want you to tell me based 10 upon your knowledge of that population, if that is an 11 accurate statement? 12 A. Oh, I don't believe so. I don't belie've. 13 Q. All right, can you -- 14 A. First of all, I don't know of anything I wrote in 15 1977 about this incident. And if it refers to a paper given 16 at Leon, which I think is an exhibit here, in 1978, what I 17 had attempted to relate was that at the -- this was in 1953, 18 we were able to determine that there were at least 111 19 persons with chloracne who had been exposed to the 2,4,5-T, 20 2.4.5- T synthesis, but not to the accident material, and it 21 wasn't prior to -- to my knowledge as I recall, in 1949, the 22 company was really alerted to the fact that something in the 23 2.4.5-T operation was causing chloracne, and they were first 24 alerted by the accident. And then when they went back to 57 1 look at others, they found out that, yes, a few of them did 2 have some chloracne. But it was in 1953 or '55, I'm not 3 really altogether sure, that the figure of ill emerged as the 4 population which was exposed to the manufacture of 2,4,5-T, 5 not the accident material, and also developed chloracne, 6 Nov/, in that same paper, there is a table which 7 reads numbers of persons involved in the various accidents 8 and the figure 228, I believe, appears and the 228 comes from 9 117 and 111. 10 Q, Okay. 11 A, So that in 1978, it v/as my impression from the 12 information that I had that there were altogether 228 people 13 who were affected by the making of 2,4,5-T as well as the 14 accident. 15 Q. Was there anybody known to have had chloracne or 16 v/ere there a 111 people known to have had chloracne prior to 17 the 1949 explosion? 18 A. X just tried to tell you, Mr. Heineman, that that's 19 erroneous. That's not so. 20 Q. Okay. 21 A. By the time 1953 came around, well '55, again I'm 22 not altogether sure, that figure of 111 emerged. And in 23 1949, v/hen they looked at others who were not involved in 24 Building 41, or had anything the do with it, they found that 58 1 there were a fev; people, yes, who had chloracne 2 Q. All right. 3 A. Now, the numbers I can't tell you. I'm not 4 altogether sure about numbers. 5 Q. Now, with respect to the mortality studies, sir, 6 the jury has heard frequently expressed the term the 7 Zack-Suskind study. Is that the name of the study that you 3 are talking about? 9 A. Well, if you are referring to the mortality 10 analysis which we have been discussing which is entitled 11 mortality experience of workers exposed to 12 tetrachlorodibenzo-dioxin in a trichlorophenol process which 13 was offered by Miss Zack and myself, that's the study. 14 Q. Okay. Now, in connection with the development of 15 that study, would you outline for the jury the manner in 16 which the cohort was identified and who designed that manner, 17 who decided how to do it that way? 18 A. Well, I believe I've already said something about 19 it, Mr. Heineman. I believe I've already said that there was 20 a discussion between Miss Zack and myself regarding the 21 protocol for the study. And, who was to do what-, and the 22 essential objectives of the Study was to determine the jj 23 possible long-term effects of exposure to relatively high i\ 24 levels of TCDD, although we didn't& know what the levels 59 1 were. We didn't know what the health effects were and we 2 assumed that the levels \*ere high, to determine what the 3 long-term health effects were in terms of mortality risks, 4 mortality risks for 22 different categories of causes of 5 death, and, we felt that the population we needed was the 6, runaway reaction population. And, we developed a strategy 7 for getting the information. And then a strategy for the 0 analysis. And that's how this study was constructed. 9 Q. Now, with respect to the ones the cohort had been 10 identified, the 122, what was done to follow up on that, in 11 order to actually put the data together? 12 A. Well, what we simply did, and it's a relatively 13 simple kind of study, is we found out what the numbers of 14 deaths were due to any of 22 different causes of death, as 15 compared with the expected number for those 22 different 16 causes of death. When we consulted the national statistics 17 in this instance for white males, because there were all 18 white males, 121 were, the person who was left out, because 19 we had obviously no way of comparing her to a national 20 statistics was the nurse, Louise Morris, who had -- who was 21 involved in the process accident material because she used to 22 go through the plant and she did a lot of nursing, practical 23 treatments of the people who had chloracne. And she 24 developed chloracne herself. And so we took her out of the 60 1 population, and then we simply determined the standard 2 mortality ratio, which is the ratio of observed, observed 3 deaths in the population, to what one would expect in that 4 population. 5 Q. All right. I'm not quite sure I understand why 6 Nurse Morris was eliminated. I wonder if you'd explain 7 that. 8 A. Well, in order to get some understanding of what 9 the difference in frequency is, the causes of death, you've 10 got to have a sizeable population, 122, 121 was small enough, 11 but you can't do it on the basis of one. 12 Q. Okay. 13 A, And we would have to compare her to white females, 14 Caucasian females, you can't compare one, because there were 15 no deaths in that population of one. 16 Q. Okay. She was still living at the time of.the ^ 17 study? 18 A. Yes, she was still living at the time of this 19 study, as well as the morbidity study. 20 Q. Now, how were the ones the causes of death were 21 determined? How were they related to the categories that you 22 talked to us about before, the categories of causes? 23 A. The categories are the causes of death, Mr. 24 Heineman. May I read them? 61 1 Q. Okay. 2 A. The categories of causes of death are all causes of 3 death, overall figure for causes of death, from any cause, 4 then all malignant neoplasms, buccal cavity and pharynx. 5 Digestive organs and peritoneum, and under that stomach, 6 liver, and other digestive organs. Then respiratory system, 7 and all aspects of the respiratory system. Then broken down 8 into lung and other parts of the respiratory system like the 9 nasopharynx, or the larynx. That i?ould also be part of it. 10 Skin? genitourinary organs. The genitourinary organs would 11 include the kidney and the testes, or the penis? lymphatic 12 and hematopoietic tissue? lymphomas like leukemia or 13 Hodgkin's disease, diseases of the nervous system like 14 problems that might lead to death that effect the nervous 15 system. This would be like multiple sclerosis. That's a 16 disease of the nervous system, or diseases of the circulatory 17 system, not malignant, like arteriosclerotic heart disease, a 18 very common disease, including coronary heart disease. All 19 other diseases of the circulatory system which would include 20 stroke. Diseases of the respiratory system like emphysema? 21 disease of the digestive system othdr than cancer, like 22 bleeding peptic ulcers, which can lead to death. And then 23 all.other diseases. Those that I've listed are the common 24 diseases. 62 1 And then the external causes of death like suicides 2 or accidents. So we looked at all of those categories and 3 determined whether any of the observed deaths fitted into one 4 of those categories, and then looked at the numbers that we 5 would have expected from looking at the Munsen tables or the 6 general population death statistic tables. 7 Q. Now, did you code those death causes in some way? 8 A. Well, yes. One looks at these death certificates 9 and then has to determine in which category they would fit. 10 And there is an international code which is used and for this 11 coding exercise we used a qualified experienced nosologist, 12 somebody who knows a good deal about classification of 13 diseases and where they fit into the international 14 classification series. For each of those categories that I 15 have listed, there is an international classification of 16 diseases code number. With -- 17 Q. Is a mortality study of this kind designed to look 18 at long-term health effects, is that accurate? 19 A, Well, not necessarily. It doesn't have to be long 20 term. But in this instance it was long term. Doesn't have 21 to be, but in this instance it was* Because, we were looking 22 at a population that had been exposed in 1949, and here we 23 were 30 years later, 29 years later, because the cut-off date 24 for deaths for this study was December 31st, 1978, but it was 63 1 essentially 30 years after the fact. Now that's long term. 2 Now, it could have been a study, there are studies that have 3 been done on mortality statistics of exposures to drugs or 4 whatever, and it's done five years afterwards or two years 5 afterwards, or a month afterward, and you could still do a i 6 mortality study. So, this doesn't -- this long term is not 7 the characteristic of this kind of mortality analysis. We 8 use it for our long-term study, 9 Q. Okay. Would you differentiate, please, between -- 10 and I get confused sometimes between a short-term or a 11 long-term health effect versus an acute or chronic exposure. 12 Can you differentiate between those two things for me? 13 A. Well, an acute exposure -- an acute exposure 14 actually designates a brief high-level exposure like in the 15 case of the runaway reaction. First came in they were 16 exposed to a lot of material and they became acutely ill and 17 then they were -- the some of the same people were exposed to 18 this material because it was still around. And they may have 19 been exposed for a week. They may have been exposed for two 20 weeks. May have been exposed for more than that, if the 21 material was still around. That would be a kind of 22 subchronic exposure, but, the effect of it -- the effect of 23 it could either be an acute effect or a long-standing effect, 24 subchronic effect like in the case of dose, those exposed to 64 1 the manufacture of 2,4,5-T as well as the runav/ay reaction. 2 Vihat happened to these people, that's a chronic effect, 3 chronic effect. What happened to these people a month '4 afterwards, two months afterwards, a year afterwards, and if 5 you are looking for long-term effect, then you have to look 6 for years afterwards- If you really are interested in what 7 happened after 15 years, or 20 years, or 30 years, you have 8 to look at the end points after 30 years, and this is what we 9 did here in this study. We were looking for what were the 10 causes of death of these people over a long period of time. 11 Q. Now, these people then is it fair to say they had 12 -- you were looking at a long-term health effect for an acute 13 exposure? 14 A. No, we are looking for the effect over a long 15 period of time, over a long period of time. 16 Q. Okay. 17 A. All right. The morbidity study on the other hand 18 addresses the issue of a health status, what is the health 19 status after 30 years. That's a long-term effect. 20 Q. Okay. Now, with the 121 people that were included 21 in the mortality study, would you tell us what you found as a 22 result of the examination? 23 A. Well, again, rather simply we found that for all 24 causes of death, we observed 32, found 32 and the national 65 1 table told us there would be about 46 deaths so that the 2 standard mortality ratio would be .69, which is statistically 3 significant, that is the P Value, which I discussed earlier, 4 is smaller than .05, and then we found that of the -- when 5 you looked at the malignant neoplasms, we had 9 due to 6 malignant neoplasms, the expected was also 9, so that there 7 v;as a standard mortality ratio of one. It was what you would 8 have expected. However, if you went and examined individual 9 causes, each malignant neoplasm or the area of the malignant 10 neoplasm, you found that there were no stomach cancers, 11 nobody died of stomach cancer. Nobody died of liver cancer. 12 And as you will remember, we found in the subchronic phase of 13 the exposure to the runaway reaction, there was liver 14 problems. We had hepatitis, and they had some dysfunction of 15 the liver. So we were looking for deaths that could have 16 been due to either malignancies of the liver or other 17 diseases of the liver, like cirrhosis. We didn't find any -- 18 30 years later -- we found that lung cancer, there was five 19 in this group, and the expected would have been about three, 20 however, we then went to find out this was statistically 21 significant, and it happens that the P Value of that SMR is 22 larger than .05, so that it is not statistically 23 significant. A small number, but still not statistically 24 significant. We found that there were three cases of deaths 66 1 due to lymphomas or hematopoietic diseases, and we would have 2 expected ,088. .88, I'm sorry, ,8. You'd expect one. But, 3 the numbers are too small, so that if you -- if you did a 4 statistical significance on it, wouldn't mean anything. 5 Wouldn't mean anything if you compared three to one. With 6 this small number of people, 32 altogether. In circulatoryi 7 diseases, there were 17 observed and one would have expected 8 25. This would be heart disease and stroke, and though the 9 SMR was .68, still wasn't statistically significant. There 10 was a trend. There was a larger number of expected than 11 observed. But, it wasn't statistically significant. If you 12 broke it down to arteriosclerotic heart disease alone, we 13 would have expected in this group, age group, would have 14 expected 13, I mean we would have expected 17, and we 15 actually only found 13. Sorry, It's 13 observed. 17 was 16 expected; And that also is not statistically significant. 17 So that in summary, I think while the cohort 18 epidemiologically is a small one, the only real significance 19 is this overall causes of death, that is statistically 20 significant. And, at the time we did it, we didn't think we 21 could draw any firm conclusions from it. Although, and I 22 have to underscore this, 30 years afterwards, if there were 23 problems involving the liver, or cardiovascular disease, or 24 pulmonary disease, we would have seen it even in this small 67 1 group, which we did not. 2 Q. Would you expect to find it in cancers after 30 3 years? 4 A. You might. The period is long enough, and if these 5 people were going to develop liver cancer, which you do in, I 6 have to point out in animals, in animals, and the papers so 7 state, animals, you can produce liver cancer with TCDD. 8 Q. And the significance -- what is the significance of 9 the fact that there wasn't any, or was there, that there 10 wasn't any liver cancer in this group after 30 years? 11 A, Well, the fact is that the liver problem such as it 12 was must have been a transient one. And we find that by 1953 13 the people we examined didn't have any liver problems. In 14 1949 and *50, those exposed to the runaway reaction did. But 15 by 1953, the liver problems, everyone has to distinguish 16 between hepatitis liver inflamation and liver cancer. And, 17 none of the people whom we saw back in '49 or who were 18 exposed to the runaway reaction ever developed liver cancer. 19 Q. Now, is it possible to consider the results of this 20 study conclusive for association? 21 A. Well, I think the report says that we weren't 22 prepared to consider this conclusive but I think that from 23 the standpoint of good statistics, but I think that even 24 though this is a small group, one has to recognize that there 68 1 are no obvious increase in causes of death from anyone at 2 anyone's site. 3 Q. Sirf with respect to studies that had been done 4 subsequently to this study by yourself and others, do you 5 have an opinion as to whether or not this study is consistent 6 with other studies that have been done on human population? 7 A. Well, the only long-term mortality study that I 8 know about is the one done by Dr* Theiss on the badische 9 aniline group. I wouldn't consider the Ranch Hand a 10 long-term study because it was a relatively short period of 11 time after exposure to Agent Orange. But X would consider 12 that Dr* Theiss' study is as this is a long-term study, 13 probably not as long a period had elapsed, and he found that 14 there was -- there were some increased risk at least for one 15 type of problem in his group. 16 Q. And that problem was what, sir? 17 A. He found an excess of cancer of the stomach. How, 18 there was no attempt to find out if there were other 19 confounding factors which we discussed this morning, but this 20 is what he found and -- if you look at ours, and ours is up 21 until the point we did this, the largest group of persons 22 exposed to TCDD after long-term follow up. 23 Q. Now, Doctor, you are aware, are you not, sir, that 24 Dr. Carnow has testified in this case? 69 1 A. Yes, I am aware of it. 2 Q. And, are you av/are, sir, that Dr. Carnow testified 3 that in June of 1984 -- * 4 MR. CARR: Date please, counsel? 5 Q. June 18th, 1984, Page 41. Testified in this case 6 that the fault to be found with this study that you've just 7 been discussing was that it makes it appear that exposure to 8 dioxin improves health and mortality; Do you agree with that 9 statement? 10 A. Well, I wasn't aware that he said that, but I think 11 it's a palpably ridiculous statement. 12 Q. Why do you believe that, sir? 13 A. Well, first of all, because if he's going by the 14 overall, the SMR for all causes of death, in a work 15 population, and American workers are known to be healthy 16 people. And it's been shown that the health of workers in 17 the last ten years has improved, twenty years, has improved. 18 So that what we are seeing here is likely to be a healthy 19 worker effect. Not -- not the effect of dioxin, 20 Q. Now, sir, you have -- oh, first of all, let me ask 21 you to identify Defendant's Exhibit 62. 22 A. This is a reprint from the Journal^of_ Occupationa l 23 Medicine. January 1980, of a paper entitled, "The Mortality 24 Experience of Workers Exposed to Tetrachlorodibenzo-dioxin & 70 1 a Trichlorophenol Process Accident." And it's a reproduction 2 of the paper we have been discussing. 3 Q. All right. 4 A. By Doctor -- my Miss Zack and myself. 5 MR. HElNEMAN: Now, with respect to -- Your Honor, 6 at this point I would like to move the admission of 7 Defendant's Exhibit 62 into evidence. 3 MR. CARR: We don't object. 9 THE COURT: Admitted without objection. 10 Q. (by Mr. Heineman) Now with respect to the 11 preparation of that paper for publication, would you tell us 12 what participation you had in that? 13 A, Well, I indicated to you what participation, what 14 my responsibility was in the organization of the protocol for 15 this study. And after the data was in, a draft of the 16 analysis was sent to me with a -- a first draft of a 17 manuscript, and what I did essentially, I was responsible for 18 all of, most of the introductory material which describes the 19 acute and subacute and chronic health effects as it -- in the 20 Monsanto Nitre population as Dr. Ash and I described it in 21 1949 and *50, and the report which I wrote in 1953. In the 22 first two pages, almost two pages were consistent material 23 that I contributed to this paper. Miss Zack assembled the 24 data, put it into tables, and I reviewed it and edited it, 71 1 and the discussion and conclusions were essentially the 2 result of our putting our heads together to determine what we 3 had to say about the data, and what we concluded from the 4 data* And there was a series of correspondence and telephone 5 calls about this, and finally I wrote to the editor of the 6 j_ournal_of_Q_cc_up_ational Medicine, Dr. Lloyd Temper and asked 7 him if he would be interested in it. He said yes, and we 8 sent him the paper. Judy Zack sent him the paper. 9 Q. Now, to your knowledge, sir, was that paper peer 10 reviewed? 11 A. I believe it was. The review would have come to 12 Miss Zack as the senior author. 13 Q. Now, at the time that that study was carried out, 14 Dr. Suskind, did the University of Cincinnati, either the 15 University of Cincinnati or you yourself personally receive 16 any compensation from Monsanto Company for that study? 17 A. None whatsoever. My participation in it did not 18 involve an application for funds ror did we receive any funds 19 for my participation. 20 Q. Nov;, Dr. Suskind, you spoke earlier about a 21 morbidity study. I wonder if you would briefly tell us what 22 a morbidity study is. 23 A. A morbidity study is a study of the state of health 24 of a population at a point in time, and it usually consists 72 il 1 of a definable cohort which is looked at, examined, variety 2 of ways, and to determine what the state of health is of that 3 cohort, individually, and collectively. And if, for example, 4 one is looking at an attempt to relate increased risks for 5 specific kinds of disease processes, whether they are 6 elicited by history, whether the diseases are elicited by 7 history or by examination, one does then look at, examine a 8 number of organ systems that one would like to see if there 9 is any risk for disease* 10 Q. Now, you've used the term protocol, sir. What -- 11 how do you develop a protocol for a morbidity study? 12 A. Well, a protocol is simply an attempt to provide a 13 design for the study. It identifies objectives of the 14 study. It identifies the population that you are going to be 15 concerned with, the characteristics of that population, for 16 example, if there is going to be an exposed group and the 17 control group. It would identify what kind of exposure, how 18 many people you would anticipate putting into a cohort, and 19 what your control group would be like. Whether it would be 20 an external control or internal control group. Then you 21 would determine -- you would describe, what you were going to 22 do with this population. How you were going to examine this 23 population in order to accomplish your objectives. What 24 kinds of examinations, what the scope of the examination 73 1 would be, and then who would be being the examination and how 2 it would be carried out. 3 And then finally what kind of data organization you 4 would anticipate, and what kind of analysis of the data you 5 would desire. 6 Q. And, would you explain the difference between an 1 internal control group and an external control group? 8 A. An internal control group is usually a group which 9 is chosen from perhaps the same plant or the same industry 10 and matched for demographic factors, if it's possible to do 11 that, but it's much more possible to do that sometimes in an 12 internal control than an external control. 13 An external control means going to another industry 14 or another plant or another population. 15 Q. What are the practical limitations that an 16 epidemiologist finds himself faced with in developing a 17 protocol for a study; deciding to select the control group 18 and what kind of control group you can have? 19 A. Could you repeat the question, Mr. Heineraan? 20 Q. Certainly* Excuse me for being so obtuse with it. 21 Let me try it a different way. When an epidemiologist 22 approaches a problem or a study, are there practical 23 limitations within which that study has to prey, based upon 24 the group and the population and that sort of thing? ________________________________________________________________ 74 1 A. There are always problems of that sort that face 2 epidemiologists. In order for a study to have the power to 3 determine significant differences, the power to determine 4 significant differences, you have to have a significant 5 number of people involved, so that numbers are important and 6 very often when you are dealing with an industrial 7 population, you cannot fulfill the pristine requirements of 8 classical epidemiology from numbers. But you have to do as 9 best you can. You do the best you can and you get as much 10 information as you can out of a limited number of people. 11 Now, that's usually the case when you are studying or about 12 to study an industrial population. And particularly if that 13 industrial population was exposed him many ago, as in the 14 case of the Nitro group. 15 Q. Nov; -- 16 A. Go ahead. v 17 Q. I'm sorry. Did I interrupt you? 18 A. NO. 19 Q. The particular morbidity study that you conducted 20 at Nitro, who are the authors of that study, sir? 21 A. The authors of this study are Hertzburg, a 22 biostatistician, and myself. There were a lot of 23 professional participants in that study, especially in the 24 carrying out of the examination, and developing a strategy 75 1 for doing the study. But the major authors of the study are 2 myself and Dr. Hertzburg. 3 Q, Would you characterize this as Monsanto's study, 4 sir, something engineered by Monsanto Company? 5 A. No. I'm always amused to hear that, but I have to 6 tell you that years before we did this study, we had been 7 attempting to, as the records will show, to get a study 3 done. And, the study from beginning to end was conceived, 9 developed, and the outcomes were analysed by myself and my 10 staff and it's a University of Cincinnati study. 11 However, we couldn't have done this without the 12 assistance of the group that ran the plant. They knew what 13 the population was all about. They had the records, the 14 employment records, the health records, the workman's 15 compensation records. We didn't. So we had to depend upon 16 them to provide us with a population to recruit from. Also 17 from a strategic standpoint, needed assistance if we were to 18 carry out that study in the locale of the Nitro plant to make 19 it accessible to the workers there or the former workers who 20 lived in the area. 21 So that the study itself was a University of 22 Cincinnati study with me as the principal investigator and 23 Dr. Hertzburg as the coauthor of it, since she helped analyze 24 the data and organize it, a most important function in a 76 1 study like this. 2 Q, How was this study funded, sir? 3 A. Study was funded from three different sources. It 4 was funded by the Environmental Science Center through a 5 grant and the resources for doing a lot of these studies 6 including the organization of the team and the resources that 7 the team used, including the analytical work and the access 8 to the computer, and the coders and all that, those were all 9 supported by the resources at University of Cincinnati, were 10 supported by the NIHS. Now, some of our salaries were paid 11 for by the University of Cincinnati, including mine. And 12 Monsanto, we attempted to determine how much it would cost to 13 do it in Winfield, West Virginia, where it was conducted with 14 -- where the examination was fully conducted, and we got a 15 budget up, which included the cost of the various functions, 16 including some of the people and their travel and Monsanto 17 bore the cost of carrying out the study on site. Except for 18 -- well, the participation of myself and the participation of 19 the two people from NIOSH, and the participation of the two 20 physicians from the Air Force. They didn't take care of 21 them, of course 22 Now, when you say the on site expenses, you are 23 talking about someplace to house it, someplace to house it, 24 the renting of the space, the clinic, the nurses then people 77 1 from Monsanto and that clinic that we used who assisted us in 2 carrying out the actual examination. When you do a study 3 involving 436 people over a period of more than 10 days, 4 there has to be a real good organisation so that the flow of 5 traffic from the taking of the samples of blood and urine and 6 to x-ray and ECG and nerve conduction velocity, to taking 7 vital statistics and the interview, all that has to have some 8 kind of traffic management, and the Monsanto people were very 9 helpful, in doing that. We had our own coordinators, yes, but 10 without them, we probably wouldn't have done as good a job or 11 as effective a job. 12 Q. This was people from the plant assigned to help? 13 A. People from the medical department of plant. 14 Q. I see. They just help move things along, I guess? 15 A. Right. 16 Q. You looked at how many people? 17 A. 436. 18 Q. Go ahead. Now, who conducted these interviews that 19 you mentioned? 20 A. Well, these interviews were actually conducted by a 21 team of trained individuals who were recruited by us from the 22 University of Cincinnati, and they included nurses, nurses 23 who had training in occupational health nursing and further 24 training in interviewing people for such a study. They 78 1 included graduate students, senior graduate students in 2 toxicology who were involved in therapy, also trained to do 3 the interviewing, and they were very good. And, the number 4 of interviewers were about six, and they were all from the 5 Department of Environmental Health. 6 Q, Did any Monsanto personnel participate in the 7 actual conduct of the study? By that I mean the interviews, 8 the physical examinations, the laboratory work, any of that? 9 A. No, not at all. The Monsanto personnel were 10 helpful in transporting people from the plant or there were 11 retirees who came in from outside the city who were living in 12 hotels or motels and they were transported by Monsanto people 13 to the place of examination. They also helped -- that is 14 again people from the medical department helped in making 15 sure that people got to the place of the interview and 16 examination on time. They transported them. They made sure 17 that people who had to have their blood drawn before 18 breakfast because we were doing chemical studies of blood on 19 fasting persons. Make sure that they got to the proper place 20 for the drawing of blood, and now the preparing of the sample 21 was done by ourselves. But they helped in making sure they 22 got to the place where the bloods had to be drawn and the 23 urines were received and following that they made sure they 24 had breakfast, because they were hungry people. 79 X THE COURT; Is this a good point for a short 2 break? 3 MR. HEINEMAN: Pine. 4 THE COURT; We will take a short recess at this 5 time and then resume testimony. The admonishments that I 6 gave you earlier will apply during this break also. Court is 7 in recess. 8 (The following proceedings were had in open court.) 9 Q. (by Mr. Heineman) Dr. Suskind, with respect to 10 making a determination as to who should participate in this 11 study as Monsanto employees and former employees, how did you 12 learn that information? How did you understand who it was 13 that was going to participate? 14 A. Well, it wasn't that we knew who was going to 15 participate, we decided on what the criteria were for 16 participation. That was our job. But we needed to know how 17 many persons were still living, where they were, and whether 18 they were retired or terminated or still active, who had been 19 exposed, and then of course we wanted an equivalent control 20 group. 21 Nov;, originally we had thought that we should be in 22 the original protocol. We thought that we would want a total 23 population of anywhere from 450 to 500 with approximately 150 24 to 200 people who had chloracne and had been exposed. And 80 i ~I 1 then people who did not have chloracnejbut were exposed. And 2 then another population unexposed, and it turned out that 3 when we looked at the information, which was gleaned from 4 records that there were about 806 persons who would have 5 qualified for the cohorts that we were seeking. And we got i 6 from Monsanto lists of people who were! exposed and had 7 chloracne and exposed without chloracne, and now these were B both people exposed to the runaway reaction as well as the 9 manufacture of 2,4,5-T. And then peopllI e who were so-called 10 intermittently exposed. We are never sure about what that 11 really meant, except that they have bejen in and out of the 12 process and they may or may not have had chloracne. Most of r 13 them in that list that we got of so-called intermittently 14 exposed did not have chloracne. Some of them did. A few of i 15 them did, and then there were those who were unexposed, and i 16 who did not have chloracne. We felt -r and this was after ii 17 discussion, that we could recruit in thiiie time that we had to 18 do it, and this was between early February and June when we i 19 wanted to do our examination, all persons active or 20 terminated or retired who v/ere exposed! to the runaway 1 21 reaction. We wanted to have that groupii in as a population to 22 be recruited. And all of the active gr retired, who were 23 exposed to the 2,4,5-T that had chloracne with records of it, l 24 that is workman's cornp records, those were in the recruitable \i 81 1 population within the time that we had to do it. And, all 2 active or retired, retired who were exposed to 2,4,5-T 3 without chloracne in this group, it was almost impossible to 4 locate because there were no records of it without 5 chloracne. There were no records of where they were. So, 6 that the terminated individuals which would be -- were 7 different to find, they were essentially not recruited. 8 And then there was a control group of unexposed. 9 We also felt that when we looked at this group of 800, that 10 we had to exclude or should exclude, because it would only 11 confuse the issues. People who were born 1951 or afterwards, 12 by 1969, when the process of making 2,4,5-T ended, they would 13 have probably been 18 years old or younger. And we felt that 14 that would -- that would prejudice the -- askew the age 15 match, which we felt would be difficult to do anyway because 16 the exposed group was a new and older group, and we ended up 17 with inviting 1,800 and 6,431 who were known to be exposed 18 and 375 with no known exposure. And, letters were sent out 19 first by the plant manager, Royce Scott, and in forming that 20 population that there would be a study conducted in June, and 21 I believe the letters went out in February of 1979. And, 22 follow-up letters were sent as well and then the plant 23 newspaper had stories about or publicity about the 24 examination which was to be conducted. And then later on, I 82 1 wrote letters as well and the letters that X wroter because 2 of the ease with which they would be delivered was sent 3 actually by the plant managers office at Monsanto, And 4 that's how we did our recruitment and that's how we attempted 5 to assemble our cohorts. 6 Q. Let me hand you, sir, what's been marked as 7 Defendant's Exhibit No. 1702, and ask you if you would 8 examine that and identify it for me, please? 9 A. This is a letter with the stationery of the 10 Institute of Environmental Health at the University of 11 Cincinnati with myself as the Director, dated May 16th, 1979 12 addressed to Monsanto retirees, I believe there were two such 13 letters and this one was addressed to the retirees informing 14 them of the study which would be conducted during the week of 15 June 11th, 1979, of workers and retirees from Nitro, and that 16- it would be a comprehensive examination, and he also informed 17 them that we had begun the phase of this study in 1977 when 18 we initiated an epidemiologic study with the epidemiologic 19 team at Monsanto, and I believe we referred to the work we 20 were doing with Judy Zack. 21 Q. And, who is -- 22 A, We also included a return card indicating what day 23 would be most convenient for their participation, and the 24 fact that travel expenses would be paid for out-of-town 83 1 participants and the hours of the examination and how long 2 the examination would require* 3 Q. And who signed that letter, sir? 4 A* I signed the letter. 5 Q. All right. The second page is what, sir? 6 A. Second page, I believe, is the reverse side of the 7 post card which asks to be returned whether you intend to 8 participate or not, and there is a line with an area to check 9 I will participate in the health examination, and another 10 line I will be unable to participate, and the two most 11 convenient days to be circled, and the persons to call for 12 additional information about assistance in transportation. 13 These people were two very helpful Monsanto employees, one of 14 them is Owen Dolen, and the other is the nurse Sarah Anthony, 15 both of whom were very helpful in the scheduling as well as 16 the strategy of carrying on the examination. 17 MR. HEINEMAN: Now, if the Court please, Your 18 Honor, we'd offer Defendant's Exhibit 1702. 19 THE COURT: Any objections? 20 MR. CARR: None, Your Honor. 21 THE COURT: Admitted without objection. 22 Q. Let me hand you next what's been marked as 23 Defendant's Exhibit 1703, and would you identify that for us, 24 please, sir? 84 ] 1 A* This is a letter with the same date and stationery 2 University of Cincinnati, Department of Environmental Health, 3 signed by myself, which indicates as well and this was 4 addressed to Monsanto employees, that there would be a health 5 examination of Monsanto workers and retirees in Nitro during 6 the week of June 11th to 18th and that it would be a 7 comprehensive examination and many tests would be made to 8 determine the state of health of each individual and to 9 identify health problems which might be related to 10 occupational environments. And again we write about the 11 epidemiologic study which was underway at the time, as well 1 12 as inserting a post card for a reply from the individual to 13 whom this letter is addressed asking to check off whether 14 they will or will not participate and what the two most 15 convenient days were. 16 Q. Nov/, sir, one letter is to retired persons and one 17 letter is to current employees, is that right? 18 A. Right. 19 Q. Was an identical letter sent to every retiree? 20 A. An identical letter was sent to every retiree, yes. 21 Q. And how about every employee? Was an identical 22 letter sent to every one of them? 23 A. Yes, to my knowledge, it v/as. 24 Q. Was there any -- 85 1 A That included the 886 individuals 2 Q. Was there any effort made to dissuade anybody from 3 participating? 4 A. If there was, we would have quit, Mr. Heineman. 5 Q. So the answer to my question, sir, is there was 6 not? 7 A. Not to my knowledge. 8 Q. And, you mentioned a moment ago that Mr. -- 9 A. Owen Dolen. 10 Q. Owen Dolen and Mrs. -- 11 A. Sue Anthony. 12 Q. Mrs. Anthony participated in it. Was it the 13 strategy of the examinations, did I understand you correctly? 14 A. They participated in the carrying out of the 15 examination, but they also participated in the recruitment, 16 because they followed up these letters especially if there 17 were replies that were uncertain, or if there were two dates 18 chosen they had to give them one day to participate, and they 19 would then call this individual back to tell them what day 20 they were going to participate. 21 Q. Now, what exactly did these two individuals do in 22 connection with the examinations themselves? 23 A. Mr. Dolen didn't do anything about the examination, 24 he was the -- he assisted in the strategy of recruitment and 86 u 1 strategy of getting the people who had been recruited to the 2 examination with proper transportation and so on. 3 Mrs. Anthony was very helpful in the scheduling, 4 along with our coordinator, Pam Winter, who was a very 5 effective administrator, happened to be a graduate in 6 industrial hygiene, and she was a very efficient coordinator 7 and she and Miss Anthony and others from the medical 8 department at Monsanto really organized the scheduling of the 9 436 individuals over a period of 10 days or more. 10 MR. HEINEMAN: Now, first of all, Your Honor, I'd 11 like to move the admission of Exhibit 1703* 12 MR. CARR: Again, we have no objection. 13 THE COURT: Admitted without objection* 14 Q. (by Mr. Heineman) Nov;, when you got a list of 15 these 800 and some people, did you get any records from the 16 -- from Monsanto with respect to those 800 people? 17 A. Well, I'm not altogether sure my memory is correct 18 that we got them at the same time or later, but we did 19 eventually get the medical records, the medical records of 20 the people who were recruited and the work records as well. 21 Q. Now, did I understand you to say that Monsanto 22 provided you with their impression as to who was exposed and 23 who wasn't? 24 A. Well, I don't believe it was an impression, I think 87 1 that they went through their records, and they determined, I 2 believe, that the department of -- or Division of 3 Epidemiology, their office, went through those records to 4 determine where each of the individuals on this list of 806 5 could be classified, whether they were in the active employee 6 list, and they were exposed with or without acne, or v/hether 7 they were unexposed and didn't have acne, 8 Q. Now, in making your determination in conducting the 9 study as to who was exposed and who wasn't exposed, what did 10 you rely on? 11 A, Well, after the examination was conducted, we 12 looked at the histories that we took from the workers 13 themselves, and we contrasted them with the work histories 14 that we got, or the categories that they were placed in by 15 Monsanto, and we found that there were really some 16 discrepancies between the workers concept, and the work 17 histories were very thorough, as to whether they were indeed 18 working in either Building 41 or 34 or 51 or 92, which were 19 the exposed areas, or whether they v/ere maintenance people 20 and mechanics that had access and v/ere assigned to those 21 areas, so in some instances there was a discrepancy and some 22 of the people that Monsanto had designated in those sheets as 23 unexposed, we felt they were exposed, and also there were 24 some instances where the opposite v/as true. So, v/e really 88 1 relied for the final cohort designation of exposed and 2 unexposed/ and we decided that we had better just use those 3 two categories, and we also developed a third category and a 4 third category was questionably exposed. There was some 5 doubt in our minds as to whether they were really exposed to 6 the 2,4,5-T process. And there were over 50 of those in our 7 group. So that we really had in the final cohort designation 8 three groups, exposed, unexposed, and questionably exposed. 9 And then what we decided to do was to not use chloracne as a 10 criteria for a cohort, but to use it as a variable. This 11 would allow us to determine who among the exposed had 12 chloracne, what the severity was, who among the non-exposed 13 had chloracne, and who among the questionably exposed had 14 chloracne, and then we could use chloracne as a variable. 15 And, it was a very important variable. That is did they ever 16 have chloracne, did they have chloracne in the past but we 17 didn't find it on examination, or did they, or was there 18 residual chloracne. And those were three variables we used, 19 but not in establishing a cohort. 20 Q. Now, that's what I want to get back to for a moment 21 in establishing the cohort. In those instances -- well, as 22 between the way Monsanto designated them as exposed versus 23 unexposed, and on the other hand the way the people who 24 participated classified themselves by work history, which did 89 1 you rely on in classifying them for your study? 2 A. We relied to a large degree on the workers' history 3 of exposure and we knew what buildings were involved, and the 4 workers themselves were very alert and conscious of the fact 5 that they might have been exposed if they had worked in an 6 area as a maintenance worker or a hauler or whatever Andr 7 we relied on those histories as the -- as the criteria for 8 designating exposed versus non-exposed and questionably 9 exposed. We also did this -- we had to make some judgments 10 which were important. We also went to the work records to 11 find out whether or not indeed there was any evidence of 12 exposure in the Monsanto work records. Wow, the work records 13 had some limitations. The work records didn't tell us what 14 the worker handled in that building or in any of the 15 activities. It usually provided designation as to known 16 classification, and sometimes assignment to building but not 17 what they did in that building. 18 Q. Okay, So when you said you relied upon the workers 19 history, that's the history that that worker gave to your 20 interviewers during the study, is that right? 21 A. Yes, indeed. 22 Q. And not how far Monsanto had characterized them? 23 A. Yes. 24 Q. Now, were there instances in which Monsanto 90 1 characterized them as unexposed but the worker characterized 2 himself in such a way that you believed he was exposed? 3 A. Yes, there were, 4 Q, Okay, Were there instances in which Monsanto would 5 characterize a person as exposed but from what you got from 6 the worker you drew the conclusion that he was unexposed? 7 A, Urn, there were a few, and there were more of the 8 so-called intermittently exposed, which the Monsanto 9 classification of intermittently exposed in which we found 10 discrepancies. We didn't use the designation intermittently 11 exposed. We used a designation of exposed, unexposed, and 12 then questionably with respect to what the 13 workers told you about their exposure, were there just -- 14 would they just say, well, I was exposed or unexposed or 15 would they be questioned about where they work, what they 16 did, that sort of thing? 17 A, Yes indeed, there certainly were questions within 18 the work history material, the questions which allowed us to 19 determine whether they were exposed and what they did, what 20 they did so that they felt that they were exposed, 21 Q, Okay, Now, I'm not sure I understand about the 22 difference between the group originally identified that you 23 wanted to include in the study, as compared to the group that 24 you eventually sent invitations to. Did I understand there 91 1 was a difference between the tv/o? 2 A, No, not at all. We sent invitations to everybody 3 who we felt would be recruited, or satisfied the criteria 4 that we set. And there were 806 of them. 5 Q. Okay. 6 A. And we didn't know -- we didn't know at that time 7 whether they were intermittently exposed or how they were 8 exposed, with or without chloracne. These were people who 9 were employed or retired or terminated and had worked or were 10 working at Monsanto. 11 Q. Was there an original protocol for recruiting or 12 criteria that you would look for? 13 A. Sure, but you had to start out with -- you had to 14 start out with a large group and then determine what class 15 they were going to be put in. What if we originally in our 16 original protocol wanted people with exposure and chloracne, 17 or exposure without chloracne, or no exposure, no chloracne, 18 we would have gotten that eventually, and we did. We did. 19 We got a list of the people that Monsanto felt were exposed 20 with chloracne or exposed without chloracne, or they had an 21 intermittently exposed group which we didn't participate 22 prior to when we originally v?rote the protocol, with or 23 without chloracne and an unexposed group. 24 Q. Okay. 92 1 A. So that in a sense, the information that we got, 2 the list that we got also allowed us to determine what 3 Monsanto felt the cohort that they might be put in. 4 Q. Were there people that you couldn't trace? Was 5 there anyone you couldn't trace? 6 A. Well, I assume that there were. These were -- the 7 lists that we got were the only traceable people. The 806 8 were the traceable people. 9 Q. I thought I understood you to say something about 10 the people who had been terminated. Could you phrase 11 everyone who had been terminated either voluntarily or in 12 voluntarily? 13 A. Wo, that's why -- that's why they were that 14 recruitable, because those who were terminated and had no 15 medical records, like workman's comp records, were difficult 16 to trace. They might have been traceable if we had months in 17 which to do it, but we didn't. 18 Q. Now, what about the people who had been exposed in 19 the *49 runaway reaction? 20 A. They were all traceable, because they all had 21 medical records and workman's comp records. 22 Q. Okay. 23 A. Whether they were retired, terminated, or active. 24 Q. Which group did you feel was the most heavily 93 1 exposed, the highest exposure group? 2 A. Well, I think we have discussed that before, Mr* 3 Heineman, and I think that we had felt that originally that's 4 why we did our mortality analysis, that the group that was 5 exposed to the runaway reaction was the most heavily exposed, 6 Q, Now, with respect to the questionably exposed 7 group, did you include the questionably exposed group in your 8 ultimate paper written with respect to this study? 9 A* Yes, we did. Yes, we did. However, because of the 10 length of the manuscript, the editors of the Journal of the 11 American Medical Association felt that it had to be shortened 12 and we had to make a choice as to how to shorten it. And one 13 of the ways that we could do that was to take the exposed and 14 take out the questionably exposed and take out the data of 15 the questionably exposed so we were just comparing the data 16 on the clearly exposed versus the clearly unexposed, so that 17 the final manuscript which was submitted for review contained 18 those data on the clearly exposed and the clearly 19 non-exposed, and that was the material which appeared in the 20 publication in the JournaJ, _of_ the American. Medical 21 Asso&iatisn* 22 Q, Now, with respect to the control group, the clearly 23 unexposed group, were they an internal control group? 24 A. Yes, they were an internal control group. 94 1 Q. And, on what basis did you make the determination 2 that they were clearly unexposed? 3 A. On the basis of the fact that in their work 4 histories, there was no evidence on the review of their 5 records, the work history records that we took, that we 6 elicited. There was no evidence that they were ever exposed 7 to the 2,4,5-T material or operation. 3 Q. Were there occasions when these work histories that 9 you took conflicted with what the Monsanto records of work 10 history showed? 11 A. Well, as I pointed out, in some instances many 12 instances the work records that we got from Monsanto did not 13 designate frequently what building they were in, or what they 14 did, so we had to depend upon the worker to tell us that. 15 And, the work histories were not marked exposed or not 16 exposed. No such designation on a work record. Work record 17 is really a personnel record. And, the personnel record 18 simply designates assignment, classification of job, and 19 where they worked. Sometimes, if it was a pipefitter or 20 maintenance worker or machinist, sometimes they were 21 floating, and they would be in many parts of the plant, but 22 that wasn't on the work record, just the job was on the work 23 record. So, we had to elicit from the participant where they 24 worked, did they ever work in Building 41, or 34, or 51. 95 1 Q. Now* with respect to the, I believe 436 who 2 volunteered to participate, were there any others who ended 3 up participating in the study? 4 A. No, the 436, Mr* Heineman were the number o people 5 examined, not the number who were recruited before the 6 examination. The final number examined. 7 Q. Right. 8 A. Now, some of those people, because we continued, we j 9 wanted as many participants as possible, some of those people 10 actually said that they would participate in the examination 11 during the week of the examination. And we turned nobody 12 down. And some of the people who volunteered were active 13 employees, not exposed. Some of them were active employees, 14 exposed. So -- but the total number that we examined during 15 that week were 436, 16 Q. And they included people then who were not in the 17 original list of invitees? 18 A. No. Those were all invited, but they didn't choose 19 to participate originally. 20 Q, So they changed their mind? 21 A. Yeah, there was just one individual who was not 22 invited, and we can discuss that and the reasons for our 23 wanting to examine him. We can do that later on. 24 Q. Okay. Now, would you tell us who it was that 96 1 conducted this study, who participated in it, with respect to 2 the University of Cincinnati, and anybody else that assisted? 3 A. Well, the people involved in the examination itself 4 from the University of Cincinnati included the program 5 coordinator Pamela Winter who had designed the strategy of 6 the examination along with Susan Anthony and Owen Dolen and 7 myself and paid many visits to Nitro before the examination 8 took place. And there was myself as the principal 9 investigator and the responsible person for the examination. 10 Then there were a group of physicians and they included a 11 number of dermatologists, five physicians who were trained 12 and certified in occupational medicine, two scientists from 13 NIOSH, who assisted in the conduct of the nerve conduction 14 velocity part of the study. And two medical officers from 15 the Air Force, who asked to participate because they were 16 preparing the protocol for the Ranch Hand study and they 17 wanted to see how an examination of the size that we did was 18 conducted. Their study was a much larger one involving a 19 larger population and conducted later. There was -- there 20 were four registered nurses. There was in the design of the 21 study, there were two people from the department who are 22 biostatisticians. They were were helpful in the design of 23 the study. There were two persons who did run our pulmonary 24 function laboratory in the department, and they were involved 97 1 in running the pulmonary function tests at Winfield where the 2 examination was conducted. 3 Q. Excuse me, when you say in the department, you mean 4 5 A. In the Department of Environmental Health. 6 Q. At the University of Cincinnati? 7 A. University of Cincinnati. There were four graduate 8 students, sorry, three graduate students, who were trained 9 and assisted in the conduct of the nerve conduction velocity 10 examinations which was supervised by the two people from 11 NIOSH. There was three laboratory technicians and there were 12 six trained interviewers. Among these interviewers there 13 were nurses, and senior graduate students in toxicology, who 14 received training in interviewing before we went to West 15 Virginia, and the business officer for our department, at 16 least in this study, v/as Mr. Curtaine, who is the senior 17 business manager of the department. 18 Q. Now, was there a particular form that you used in 19 order to conduct the interviews and the physical examination? 20 A. Yes, there was. 21 Q. Let me hand you, sir, what's been marked as 22 Defendant's Exhibit 1704, ask you to examine that and 23 identify it for me, please? 24 A. This is a reproduction of the 29-page form which 98 1 was used by the examining personnel including the 2 interviewers and the doctors and the people performing the 3 tests. And it includes a large number of items for the 4 interviewer to question about and for the physician to 5 complete including a physician's history as well as the 6 record of his physical examination and the abnormal findings 7 and the impression on diagnosis. 8 Q. Okay. Is that the form used in the Nitro morbidity 9 study? 10 A, This was the form used by the interviewers and 11 examiners at the study that we conducted. 12 Q. Would you briefly tell us, sir, if you would, the 13 kinds of information that that elicited, particularly by the 14 interviewer? 15 A. Vie11, on the front of this document, and I don't 16 believe it's included in the form that you have here, is an 17 informed consent statement, so that this is really 18 incomplete* It should contain an informed consent statement, 19 which the participant had to read and sign, and it provided 20 us with the agreement for the person to participate in the 21 study, and to understand what the parameters of the study 22 were. 23 Q* This is a requirement by the university, by the 24 Public Health Service, so that that was also part of the 99 1 form. There is a second page which is, I believe, omitted, 2 and as you see this document starts on item 18 and 19, and it 3 should really start on item 1 4 Q. All right, 5 A. This is to be complete# And I think that it's kind 6 of necessary to understand what the complete examination, 7 complete form consisted of# The second page, the head sheet 8 is missing, the consent form. The other thing that we need 9 is Page 1 of this questionnaire and that is some of the 10 demographics, name, address, telephone number, social 11 security number, present status, active, retired, terminated, 12 the current department, title, clock number, very important 13 information, and then as this starts on Page 2, we have again 14 the personal data, birthdate, sex, race, ethnic origin, 15 marital status, number of marriages, education# These things 16 are kind of important, and I don't think that one should say 17 well, yeah, that goes on in all records, but if you are to 18 compare two groups, you want to make sure that you compare 19 them with respect to age and education and marital status, 20 because those parameters or those variables can be 21 influential. 22 Then there is an occupational history. And there 23 are really four pages for occupational history, what their 24 job titles were* the department, and main jobs when they 100 1 started this job, when they worked for Monsanto, and there 2 are 15 lines to indicate, because some of them had worked for 3 Monsanto for many years. We had to find out where they 4 worked and what they were exposed to. So we went back 30 5 years if we had to, and all of their jobs, the job title, the 6 dates, and what they did, and this information was really 7 very important, because it told us whether they were exposed 8 or not exposed. What you did. A work description was really 9 critical and there are 15 different lines for that. Some of 10 them who hadn't worked with Monsanto long could be covered in 11 two lines, but some of them took all the fifteen lines. 12 Then, if they were retired or terminated, what they did 13 since, that was important, too. If they were retired ten 14 years ago and they went into the construction business or 15 were terminated ten years ago and went into the -- into 16 another industry, we had to know what they did in that other 17 industry. And there are a large number of lines for that, 18 and what they did before they worked for Monsanto. So, that 19 the history of the work history was rather critical and to 20 find out what they did before they worked for Monsanto, what 21 they did after they may have worked for Monsanto, and other 22 kinds of employment while they worked for Monsanto, too. 23 Some of the confounding factors that we had to 24 contend with. Some of these people were miners before they 101 1 came to Monsanto, it's a mining area, and if they had x-ray 2 findings of pneumoconiosis, black lung, or x-ray findings of 3 black lung, it didn't come from the Monsanto job, it came 4 from the mine. So we had to know all of these things. Some 5 of the people who were active did mechanical work on the 6 side, worked the gas station. Or they did farming. Many of 7 them did some farming, and we wanted to find out what they 8 were exposed to on these other jobs, dust, solvents, 9 pesticides, welding, fumes, solder, fertilizer. Were they 10 exposed to weed killers on their other jobs, so that X think 11 you can tell by that that we made every attempt to get a 12 pretty thorough history, and we felt that the interviewer 13 should pay attention to all of that. 14 We were then concerned with the work hygiene at 15 Monsanto. Did they smoke at the work site? Did they eat at 16 the work site? Did they wear long sleeves or short sleeves? 17 Did they wear gloves or aprons or protective sleeves or masks 18 or boots or respirators, eye protection. We wanted to find 19 out what kind of protection they actually used during any job 20 that they had. Not just if they were exposed but any job 21 that they had; whether their clothes were laundered; whether 22 they were laundered at Monsanto or whether they were 23 laundered at home. Did they take advantage of the lockers 24 and the showers that were provided by Monsanto later on in 102 1 the fifties, and use the personal hygiene facilities. Did 2 they use a waterless hand cleaner? Did they supply the soap 3 themselves. And then we asked them perhaps a leading 4 question, but it really had to be asked, and that was did you 5 ever develop an illness which you believe related to the work 6 at Monsanto. And, in some instances we got the answer yes. 7 And we -- and if yes, where did you work at the time? What 3 type of work and what was the date of onset of your illness? 9 Had to find out how much they smoked. Terribly important. 10 So, we got a history of when they started to smoke. If they 11 smoked cigarettes or a pipe or tobacco. If they now smoked 12 cigarettes at the time of the examination or they smoked in 13 the past and then quit, or they never smoked. And this was 14 an important variable because for many of the health effects 15 that we looked at, many of the like pulmonary function or 16 lipids, we wanted to know if they currently -- if they smoked 17 in the past, or if they never smoked. And that variable 18 happened to be a very useful one, and it is in almost all 19 epidemiologic studies, especially morbidity studies, alcohol 20 consumption. I think we went through this morning why we 21 need to know hov; much alcohol people drank and we had to 22 establish some criteria for determining if they were drinking 23 a lot or drinking very little. If their drinking habits 24 changed over the time. 103 1 Then we went into -- this again is important, 2 family history. Some of the problems that these people some 3 of them had, could be traced to their family. It's quite 4 well-known that cardiac complaints often run in families. 5 Problems involving lipid metabolism often run in families. 6 Sensitivity to certain environmental agents may run in 7 families. Whether they have asthma or hayfever, acne t 8 vulgaris runs in families. So we wanted to find out if the 9 father, the mother, or brothers or sisters had these 10 problems. Whether they had peptic ulcers or colitis, or 11 heart conditions, including high blood pressure or stroke, or 12 had lipid disturbances that they knew about or diabetes, or 13 liver disease such as cirrhosis or nervous or mental 14 disorders. 15 Then we came to the-item of cancer in families and 16 we wanted to know the father, the mother, the brother or 17 sister ever had cancer and what type of cancer they may have 18 had. And we had 18 types specified. Nov/, I think it's 19 important that v/e remember this, because in the analysis of 20 the data, in the analysis of the data we analyzed our data 21 according to an international code called SNOWMEN and we 22 analyzed our data and didn't lump all cancers together, v/e 23 kept them separately. And, we could total them up but v/e had 24 to know which cancers were involved. And this is not only 104 1 for family history, but especially personal history, and 2 that's the next item on Page 15, a crystal page in our data 3 bank. A history of skin problems, liver disorders, neuritis, 4 nerve injuries, nervousness, stomach ulcers, bowel trouble, 5 kidney trouble, bladder. But we asked if they had this at 6 any time. Didn't matter whether they had it in 1944 or *43 7 or 1960, but we wanted to know if they ever had it and what 3 year they had it, and was it confirmed by a doctor. And in 9 some instances we had to know what area of the body, for 10 example, if they had dermatitis or acne or abcesses, what 11 area of the body. If they had recurrent infections. It's 12 been known in animals that the immunologic defenses of 13 animals may be altered by TCDD so that we had to ask the 14 question, do you have frequent infections. This would give 15 us a clue as to whether or not they had any immunologic i 16 problems from a clinical standpoint. From a clinical 17 standpoint. And again if they ever had emphysema, asthma, 18 pulmonary edema which comes from heart failer, or from a 19 toxic agent, pneumonia, pleurisy, or stroke, and again we 20 asked them if they ever had cancer. And we listed these 18 21 categories of cancer, and asked them in what year it 22 occurred, and what type of cancer they had. Then we asked 23 were they ever hospitalized, if they were what were they 24 hospitalized for, what condition and what hospital. This 105 1 would give us an indication as to whether or not they had 2 problems which might be related to their job as well. Or did 3 they have a hernia, or a -- were they operated on for flat 4 feet, which is not likely to be occupational, but we also 5 wanted to know if they were ever hospitalised for their 6 chloracne. 7 Then we had a special category of -- we were 8 interested in gastrointestinal things, so we asked a fairly 9 large number of questions about stomach and intestines, then 10 a neurological history, including sleeplessness and 11 nightmares and muscle or joint pains, muscle weakness and 12 dizziness, depression, and then we asked about their sexual 13 history. Now, after -- I have to tell you that for all of 14 these, we again wanted to know if they had it at any time, if 15 they had it last year, or even if they had it in 1930. We 16 wanted to know and identify when they had these problems. 17 And then we had a question on reproduction, 18 marriages, dates, how many children were born alive, how many 19 died within a short period of their births, hov; many 20 miscarriages or spontaneous abortions they recalled their 21 wives having, how many still births, how many children with i 22 birth defects. And if they had problems having a family. 23 Did they want children and couldn't have them. And again the 24 number of miscarriages or still births with individual 106 1 spouses. Some of them may have had one wife, some may have 2 had more than one wife. Then we wanted to know what kind of 3 medicines they took. That's always very important in 4 determining relationship between whether or not a symptom or 5 a finding may be caused not by the job but by some medicine, 6 some prescribed or not prescribed medication which they might 7 be taking. And in that we asked if they ever had acne and 8 what kind of treatment they might have got for their acne. 9 If they were allergic to drugs or did they ever have any drug 10 reactions. And after that, it's a long history. I don't 11 apologize for taking the time to tell you about it because I 12 think it's important to recognize how thorough this 13 examination was. 14 We then went on to the examination, the physical 15 examination itself. The individual went to a nurse who took 16 vital signs. Vital signs are size, weight, height, blood 17 pressure, pulse, respiration and a general appearance of the 18 individual. Where they were, they looked sick, they looked 19 depressed or they looked well, and we wanted an impression 20 from the person who took the vital signs before the 21 individual went to be examined by the doctor and the doctor 22 took again took an additional history and took a history of 23 skin problems, respiratory problems, dental problems, eye 24 problems, problems involving swelling of nodes, problems 107 1 involving the respiratory tract, the heart, any other aspect 2 of the thorax. Whether they had any history of 3 gastrointestinal problems, whether they had a history of 4 liver problems. The history of sexual disturbances and 5 libido, again, any time, not just during any restricted 6 period. Any problems in there referable to their skeletal 7 structures, bones, their muscles. Any kidney problems, 8 bladder problems, general problems including reproductive 9 problems, blood vessel problems. Some of these people may XO have had vericose veins, and those are blood vessel 11 problems. Some of them may have had angiomas of the skin, 12 which are blood vessel dilatations in the skin. 13 Neuropsychiatric history. Then a history of infections, and 14 then the doctor examined the patient or the participant 15 thoroughly, and the skin examination was done by a 16 dermatologist. The skin examination was done by one of the 17 dermatologists. If there was need for an opthalmologic 18 examination we had a certified opthalmologist* there. And 19 then the doctor usually cited the abnormal findings from 20 history, and abnormal findings from physical examination and 21 then gave in most instances an impression or diagnosis and 22 wrote comments. 23 The individual then could have done before his 24 examination, his or her examination, went to the pulmonary 108 1 function lab where they did breathing tests, and two very 2 qualified people conducted the breathing tests, and kept a 3 record of it, which was part of the chart. And then nerve 4 conduction velocity tests were conducted, and that was 5 recorded as to what the findings were and then another part 6 of the form had a check for the laboratory tests which were 7 done to make sure that we had in our record that they had all 8 the laboratory tests which we wanted to know done. But the 9 blood samples were taken, urine samples were taken. We took 10 skin biopsies. We took skin scrapings. Since the skin was a 11 critical issue here, we wanted to make sure that the 12 diagnosis of the skin problem was a proper one, and we took 13 numerous biopsies, not only of chloracne, but other skin 14i lesions and some of them were lesions that were suspected of 15 being a skin cancer, or an eczematous lesion like in contact 16 dermatitis. We did cultures of the skin, scrapings for fungi 17 and for bacteria where they were indicated. 18 We took photographs of the participants so that we 19 had a record of them. And, of course, there was a check-off 20 sheet whether they had their x-rays done and they had their 21 EKG's done. This was all done in.Winfield although the 22 readings of the x-ray and EKG's were done in Cincinnati. 23 That essentially constitutes the examination of the 24 436, people and everybody got the same kind of examination. 109 1 Q. Dr. Suskind, who came in and did the urine and 2 blood samples? Who participated in that? 3 A. Well, the urine and blood for the regular 4 urinalyses, the urine chemistries, the blood chemistries and 5 the blood counts, we had technicians who took the blood, took 6 samples of the urine, and they prepared them for shipment to 7 the MEDPATH Laboratory, and the MEDPATH did those, did those 8 analyses. However, we had some special lipid analyses done 9 of blood and they were sent separately to a lipid research 10 center laboratory at the University of Cincinnati and those 11 -- that laboratory used the methods of the National Lipid 12 Research Project, which we felt we needed in order to make 13 sure that the lipid determinations were done correctly and by 14 an extremely well-qualified laboratory, which we have at the 15 University of Cincinnati. 16 Q. Now, did anyone from MEDPATH participate? 17 A. We had a MEDPATH representative who assisted in the 18 -- not only in the collection, but the packing and shipment 19 of the bloods and urines to MEDPATH. 20 Q. What, if anything, Dr. Suskind, was done with the 21 results of this examination? 22 A. Well, the data from the questionnaires and the 23 subject's medical history were coded by assigning -- 24 epidemiologic study, you are really not interested in names. 110 1 You are not interested in who the people are, you are 2 interested in the collective information because you are 3 comparing groups and you are comparing the results in a group 4 with a defined characteristic to a group that does not have 5 that defined characteristic so that the data from these 6 questionnaires and medical history were coded by assigning 7 values to the responses given, and they were coded according 8 to SNOWMED or this is a code using the systemitized 9 nomenclature of medicine system of the International 10 Association of Pathologists, A coding system which is used 11 universally in epidemiologic studies as well as in record 12 keeping. When a hospital record is coded for findings and 13 diagnosis, the SNOWMED system is usually used. 14 Q. Was this -- 15 A. I -- 16 Q. I'm sorry? 17 A. I say the medical history was usually coded that 18 way and the laboratory data was entered just as received and 19 then keypunched and verified. The numerical data was entered 20 into the computer and the computer data was then compared to 21 the original files for their accuracy and this verification 22 process goes on all the time, if you want to make sure that 23 the computer has received the proper information. And then 24 multiple linear regression analyses were done. When we 111 1 compared the exposed group to the not exposed group and we 2 compared as I said, we used Chlorance as the variable* Those 3 who had chloracne at any time had a history of Chlorance, 4 those who had a residual chloracne and those who never had 5 chloracne, and multiple linear regression analyses were used 6 to compare the exposed versus unexposed and the chloracne 7 groups with respect to laboratory data plasma lipid levels, 3 pulmonary function levels, all clinical laboratory values, 9 nerve conduction measurements, after adjustment for 10 covariables* Adjustments for covariables were age and 11 smoking and alcohol* 12 Q. With respect to the -- 13 THE COURT: Before you get into that next question 14 is this a good point to break? It's about ten to* 15 MR. HEINEMAN: I'm sorry, sure, Judge. 16 THE COURT: We will recess at this time for the 17 day. We will start again tomorrow morning at 9:30. I would 18 remind you as I do on any overnight break that you are not to 19 read, listen to, or watch anything about this case in 20 particular, subject matter in general, in any of the media. 21 Thank you for your attention and cooperation. 22 (The following proceedings were had in Chambers, outside the 23 presence of the jury.) 24 MR. NASSIP: Judge, I was going to explain to you 112 1 this morning but we didn't have the time -- 2 THE COURT: Right, 3 MR, NASSIF: -- That Dr. Suskind has canceled his 4 conflict on -- he's not cancelled the conflict he's just not 5 going to be available at Cincinnati for the seminar on the 6 6th and 7th, but will be there to host it on the 5th and then 7 he has -- 8 THE COURT: Run that past me again, 9 MR, NASSIF: If you remember -- I should try to do 10 this in sequence, I'm sorry I'm skipping here. Dr, Suskind, 11 originally we had advised you, would not be available on the 12 20th, 21st and the 5th, 6th, 7th of March. 13 THE COURT: Right. 14 MR. NASSIF: He is now -- he is hosting a 15 conference on the 5th, 6th, 7th. He only has to be the host 16 for the 5th, and I've advised counsel for the plaintiff of 17 those three dates. In other words, February 20th, 21st, and 18 March the 5th and said thathe will be available to finish 19 his testimony into March as we need him, subject to the two 20 days that you are going to be gone, the 13th and 14th. He 21 will be here the 17th and the other days of March before that 22 except for the 5th, 23 THE COURT: Wait a second. We are missing some 24 days here. Let me get a calendar so this makes some sense. 113 1 He had talked about being here the 3rd and 4th not the 5th of 2 -- 7th -- you are saying he can be here the 3rd, 4th, 6th, 3 7th and the rest of March until he's done? 4 MR* NASSIF: Until he's done, subject to your thing 5 on the 13th and 14th* 6 THE COURT: Which would the 13th and 14th, which is 7 when I'm in this conference. 8 MR. NASSIF: Mr. Carr has agreed to withdraw his 9 objection subject to that commitment that I have made to you 10 and I wanted to ask then, Judge, that you withdraw your 11 order. i 12 THE COURT: So in other words this is by agreement 13 that he would be gone the 20th, 21st of February, and March 14 5th. He will be available for the rest of the time until he 15 is done? 16 MR. NASSIF: Yes, sir. 17 MR. CARR: It's not by agreement. What I have said 18 is since they have committed him to be here when he's needed, 19 except for those days, that I will no longer object to it. 20 It's up to the Court. 21 THE COURT: Okay. That is agreeable with me also. 22 And, so he will be gone February 20, February 21, and March 23 5th, Okay. I will announce those dates plus those two March 24 dates. I'll just catch up on all the dates for March. 114 1 MR. CARR: The jury hasn't been told about that \ 2 24th yet/ have they? 3 THE COURT: I don't knowf but I will tell them 4 again or tell them for the first timer whatever. And, then 5 he is ours until we are done with him, basically? 6 MR. MASSIF: Yes. 7 THE COURT: Great. Good. I think that cures any Q problem that I had with him. 9 MR. NASSIF: Okay, Your Honor, thank you. 10 MR. HEINEMAN: Mo court on the 13th or 14th? 11 THE COURT: I'm on this faculty and I can't get out 12 of it. 13 MR. NASSIF: Those are it? Those are the dates? 14 THE COURT: Yes. 15 COURT ADJOURNED: 16 17 18 19 20 21 22 23 24 115 1 STATE OP ILLINOIS ) ) 2 TWENTIETH JUDICIAL CIRCUIT ) SS 3 COUNTY OF ST. CLAIR )) 4 5 I, DEBRA M. MUSIELAK, certify the foregoing to be a 6 true and accurate transcript of the testimony and proceedings 7 in the above-entitled cause. 8 Dated this ^ 0 day of February, 1986. 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 116. 1 STATE OF ILLINOIS ) ) 2 TWENTIETH JUDICIAL CIRCUIT ) SS ) 3 COUNTY OF ST. CLAIR ) 4 5 I, RICHARD P. GOLDENHERSH, one of the Judges in and 6 for the Twentieth Judicial Circuit, do hereby certify that I 7 have examined the aforesaid transcript of proceedings, and 8 certify the foregoing to be a true and accurate transcript of 9 the testimony and proceedings in the above-styled cause. 10 Dated this _____ day of February, 1986. 11 12 13 14 15 6 HON. RICHARD P. GOLDENHERSH 17 18 19 20 21 22 23 24 H*