Document Gz1Eyj54e75Q7EQ1pzo058dV4

CERTIFIED COPY 18TH JUDICIAL DISTRICT COURT PARISH OF IBERVILLE 2 - STATE OF LOUISIANA - lxt; LLOYD GLEN SMITH, Plaintiff -vs- THE DOWCHEMICAL COMPANY, , Defendant ) ) ) ) ) ) ) ) ) ) ) ) No. 37,242 DIVISION "C" . II t 1720 Zonal Avenue Suite 226 Los Angeles, California Friday, August 2, 1991 10:20 a.m. Deposition of Taken by Reported by KAYE H. KILBURN, M.D. LEWIS 0. UNGLESBY, ESQ. NANCY MADDUX, CSR No. 4300 QUORUM Wonovrioc Te+*CO'*t**ncing n Ou' offitM "ansc^ouon vtfoiaD*ng nV3#*ng Su8PQ6NA SERVICE IP0aMg#AiSmCaIgI oOotSrkA*nm*Stc. ut DISCOVERY ZX Dakanas S' * or 31? BaronData, Data Dynamics Corporatl n Call Tbll-Free Outside California 800 533-5640 Inside California 800 533-5641 FAX (213)625-1850 Local Telephone (2131625-7615 62 Deposition of KAYE H. KILBURN, M.D., called as a witness by the Plaintiff, taken before Nancy Maddux, CSR No. 4300, at Suite 226, 1720 Zonal Avenue, Los Angeles, California, on Friday, the 2nd day of August, 1991, at 10:20 a.m., pursuant to Notice. ii POU COURT REPORTERS C.ri,f,J 3>Vosii,,, ? U ,,,, 606 & Olive Street, Suite 307, Los Angeles, Calif. 90014-9976 APPEARANCES OF COUNSEL: For Plaintiff: For Defendant: UNGLESBY LAW OFFICES By: LEWIS O. UNGLESBY, 246 Napoleon Street Baton Rouge, Louisiana (504) 387-0120 ESQ. 70802 . | j 1 j DICKSON, CARLSON & CAMPILLO By: JEFFREY J. CARLSON, ESQ. ; 120 Broadway i 3rd Floor( Santa Monica, California 90406 ! (213) 451-2273 i J l QUORUM WotwwkJ* lWecontor*netftg *n our offxw*Computtr transcnonon VKieownng Key word and Pftraso Indexing SUBPOENA SERVICE ISM ASCII Onaefle*, P BaronDataPage Image or Amicua. DISCOVERY ZX OiiAette*: 5v. or 3Vi Data Dynamics Corporation 80.906 5 INDEX WITNESS EXAHINATION Kaye H. Kilburn, H.D. CO ,- ,* ' /' , , ' 1 ' ' - ''''*". `' *.''^,,H .S^ -**"V.\vL.t Cs< ;f5 77',",7 - - -J, .''^>.?;-. <.si'V, s' ' 7` - ' *;v _ [By Hr. Unglesby] [By Hr. Carlson] ' 40 : :: '^. !-..:. . .:.: ' **-' -Vi'.-' 'S*' " '"`7 '< 7"V '* *** 1 ` ND - \! . g ." ' L ^ -*J^ .2 , I-. ; ^>1^, -vS = - " ' ; -1 .-o-is 'C '`j'?<;rro " ;- v-f*.r-i. ~ : -2 ,1 - '' <. - ;r .v`T/. -'- - "! /-* V 5^7 vV'- ' rvv., ;; ` - * wmw-i.v,,: - '.' I;";' , ,. 1 ; . -. r --V`- ;--l ... ' - , / 2 ffi ~ ;.#l -j - | " I *2 *9 'k:. : :J " g "tST^V .* ? NUMBER 153^: -tFR O Vllbvd GlQn' Smith ^Exhibit :'5 I v ':`r3 1? t'-~ ' '.' *.ra "O) 5"- s,-r ` 2 i . Tabie^:^:Neurobehavioral^Tests/w^:f Measured and .-Their ^Sources, 5)0 . ^W^^Tabi^i^Lloyd Smith (LS) Compared^ . Yv-.:/5 Y- . ; :'. T (fi ' '/* .. ..---V>.'-',-.,v Sg *<-.->' ^ >'..A 3 ' ^- QUORUM WorldwxJe Tetscontemnong in our offico. Oompum irnttcr^wa Vidoatapng. Key Word and Phrase Indexing. .. SUBPOENA SERVICE Data Dynamics C rporatlon ' 80ar06 4 PROCEEDINGS N M-- O KAYE H. KILBURN, M . D . , called as acj 2 a witness by the Plaintiff, being first duly - ub &s sworn, was examined and testified as follows: 5 a C<J j3 x l** EXAMINATION r <2 <5**. oIr*t* BY MR. UNGLESBY: CO ClOO Q Dr. Kilburn, I am Lewis Unglesby. I I. 0a010 represent Lloyd Glen Smith in a suit against Dow Chemical. r '5 11 We are taking your deposition for the a ^0a)12 313 trial here in your office at the University of Southern California. You have provided me with a CV. r wj to S 014 o**r Sin O gs?15 Is this up to date through 1990 or '91? A That's through July 1991. S 16 O %rf'"o|s17 c O 18 MR. UNGLESBY: All right. I will mark this as Lloyd Glen Smith 1. [Lloyd Glen Smith Exhibit 1 Ji3 19 oj -3 SP3 o 20 aM w3 S= 21 *r {5 |^22 330 S 23 was marked for identification.] MR. CARLSON: Excuse me. Do you have a copy for me? MR. UNGLESBY: Well, I will give you this one. o </5 24 MR. CARLSON: Okay. 25 Q [By Mr. Unglesby] Dr. Kilburn, your QUORUM Worldwide Teleconferencing m our offices. Computer transcription Videotaping. Key Wort and Phrase indexing. SUBPOENA SERVICE * BaronDataIBM ASCII Doiwfln, Pag* image or Ameut DISCOVERT ZX Datura. Sv. or 3<4 Data Dynamics Corporation 8^006 , 5 Call 'Ibll-Free Outside California 800 533-5640 Inside California 800 533-5641 FAX (213)625 1850 Local Telephone (213)625-7615 606 S. Olive Street, Suite 307, Los Angeles, Calif. 90014-9976 row COURT REPORTERS C.,nf;J 2V,,v,,,,, 1 CV reflects that you are Ralph Edgington Professor of 2 Medicine at the University of Southern California School 3 of Medicine, the Director of Environmental Sciences Lab 4 since 1980. Is that correct? 5 A Yes. 6 Q And you are the editor-in-chief of Archives 7 of Environmental Health since 1986? 8 A Yes. 9 Q You graduated from the University of Utah 10 School of Medicine in 1954? 11 A Yes. 12 Q And you have had various appointments to 13 the hospitals reflected in this CV, ranging from England 14 to Southern California to Duke to New York City, Utah and 15 other places; correct? 16 A Yes. 17 Q And you are certified by the American Board 18 of Internal Medicine since 1963? 19 A That's right. 20 Q And the AmericanBoard of Preventive 21 Medicine and Occupational Health in 1983? 22 A Yes. 23 Q Specifically,Doctor, you reflect numerous 24 academic appointments and positions which we will not -- 25 and multiple publications. c- QUORUM Wortdwi0* Teleconferencing <n our offices. Computer transcription, Videotaping. Key word and Phrase Indexing. SUBPOENA SERVICE IBM ASCII DfeMfto. Pig* 1mg or Anucu*OISCOVEHY ZX DaA*ne*. 5''. or 3v* BaronDafa Data Dynamics Corporation I ROW COURT REPORTERS C.rn(;.J 3 ., 8,Q d 0 6 , 6 Call Tbll-Free Outside California 800 533-5640 Inside California 800 533-5641 * FAX (213)625 1850 Local 'telephone (213)625 7615 1 ! Let me ask you this: You have also 2 | been accepted as an expert in the field of pulmonology, 3 ! occupational medicine and internal medicine in the State 4; of Louisiana by the courts there; is that correct? 5 A Yes, it is. 6 Q And as it relates to Mr. Smith's 7 complaints, the claim that he makes regarding vinyl 8 chloride exposure and its neurological and lung damag 9 are two areas in which you have studied a large part of 10 your professional career? 11 MR. CARLSON: Objection. Vague. 12 Q [By Mr. Unglesby] You can answer. 13 A Yes. 14 Q All right. You have published in both of 15 those fields, small airways disease -- 16 A Yes. 17 Q -- and neurological manifestations caus d 18 by exposure to toxic chemicals -- 19 A Yes. 20 Q -- isthat correct? 21 A Yes. 22 Q Specifically as to vinyl chloride. 23 Dr. Kilburn, have you previously testified as an expert 24 in the courts of Louisiana and in other places in America 25 on the effects of vinyl chloride on the individual? 606 a Olive Street, Suite 307, Loa Angeles, Calif. 90014-9976 QUORUM Wtfdwxfe TtecootafnCHtQ in our offices. Computer transcription Videotaping. Key Word and Phrase indexing. SUBPOENA SERVICE IBM ASCII DaJwm. Pag* Imag* or Amtcu*. DISCOVERY ZX DskMM*. 5'-. or 3V* * BaronOata Data Dynamics Corporation 80.006 Call Tbll-Free Outside California 800 533-5640 Inside California 800 533-5641 FAX (213)625 1850 Local Telephone (213) 625 7615 2>.;, 1 MR. CARLSON: Objection. Vague, overbroad. 2 | Q [By Mr. Unglesby] You can answer the 3 ! question. ( 4A Yes. 5 MR. UNGLESBY: All right. I would attach 6 this as Smith's 1. 7 MR. CARLSON: Doctor, do you have an extra 8 copy of your CV? 9 MR. UNGLESBY: Well, yes, I can get one. 10 MR. CARLSON: Yes. I would appreciate it 11 if you could -- I mean, I can work off of this, but sh is 12 going to want to take it with her for an exhibit. 13 MR. UNGLESBY: And it's -- 14 THE WITNESS: And you want to take one with 15 you? 16 MR. CARLSON: Yes, please. 17 MR. UNGLESBY: That's not a problem. Let's 18 keep going. 19 MR. CARLSON: Okay. 20 MR. UNGLESBY: I'm sorry. I apologize. 21 I am tendering him as an expert to testify. If you want 22 to cross-examine him on his expertise, it is up to you, or 23 you can wait until later. 24 MR. CARLSON: I will wait until later. 25 MR. UNGLESBY: All right. 606 S. Olive Street, Suite 307, Los Angeles, Calif. 90014-9976 rout COURT REPORTERS QUORUM Worldwide Tettcontareocing m out offices. Computer transcription Videotaping. Key Word and Phrase indexing. SUBPOENA SERVICE IBM ASC Diskette*. Page Image or Amicus. P BaronDataDISCOVERY ZX Diskettes: $v* or 3'/i Data Dynamics Corporation 4 80006 8 Call 'Ibll-Free Outside California 800 533-5640 Inside California 800 533 5641 FAX (213)625 1850 Local 71*lephone <213)625-7615 606 a Olive Street, Suite 307, Los Angeles, Calif. 90014-9976 POLK COURT REPORTERS C.riifuJ 1 I Q [By Mr. Unglesby] Now, Dr. Kilburn, let's 2 ; talk about Glen Smith, if we may. 3 ! You saw Mr. Smith? 4 A Yes, I did. 5 Q And where did you see Mr. Smith? 6 A At Southern California Environmental 7 Medical Clinic in Long Beach. 8 Q All right, sir. And at that time what did 9 you observe were Mr. Smith's complaints? 10 A This was on June 20, 1989, and he 11 complained of some difficulty with his breathing and 12 limitation in his ability to move because of his joint 13 pain, arthritis. He also told me that he had some 14 difficulty with memory and his ability to concentrate 15 and make decisions. 16 Q How old was Mr. Smith at that time, sir? 17 A Forty-one. 18 Q Were you able to do any tests or 19 examinations of the individual? 20 A Yes. 21 Q Would you tellus -- Let'sbreak it down as 22 to his complaints of breathing problems. 23 What tests did you run and what were the 24 results? 25 A I did a physical examinationof the chest. QUORUM Worldwide Teteconierenemg in our otltcee Computer transcription Videotaping. Key Word and Phrase Indomg. SUBPOENA SERVICE BaronData,IBM ASCII OsItatMi. Page Image or Amrcus. DISCOVERY ZX Dtjkettej; 5v, or jvy Data Dynamics Corporation POU COURT REPORTERS C.rnfi..t 2> ~inmv 80006, 9 Call Tbll-Free Outside California 800 533-5640 Inside California 800 533-5641 FAX (213)625-1850 Local Telephone (213)625-7615 1 which was basically normal. He had normal breath sounds, 2 normal shaped chest, and he moved well with respiration. 3 I did a chest x-ray, which was also 4 basically normal, although his inspiration only took 5 his diaphragm down to the level of the 9th rib, which 6 is somewhat restricted. 7 His pulmonary function tests showed -8 MR. CARLSON: Excuse me, Doctor. 9 Just for the record, since this is a trial 10 deposition, could we clarify that the doctor is reviewing 11 his report as he is testifying? 12 MR. UNGLESBY: Absolutely. 13 MR. CARLSON: Thank you. 14 A [Continuing] His vital capacity was 15 reduced. His forced expiratory volume in one second 16 was also reduced, and he had reduction in flow in small 17 airways as shown by the forced expiratory flow between 18 25 and 75 percent of vital capacity and between 75 and 19 80 percent of vital capacity. 20 All of these reductions are significant and 21 lead to the diagnosis of small airways obstruction with 22 air trapping. 23 Q [By Mr. Unglesby] Can you tell us, sir, 24 whether you would anticipate in an individual 41 years old 25 who had no history of smoking cigarettes such findings? 606 S. Olive Street, Suite 307, Los Angeles, Calif. 90014-9976 QUORUM Worldwide Teleconferencing m our offices, Computer transcription. VKtaxapmg. Key vstonj and Phrase Indexing. subpoena service IBM ASCII Dakanm Pag* Knag* Almcu*. p BaronData,CNSCCVERY ZX Dokann: 5'/. or 3'4 Data Dynamics Corporation S 0 0 f) 6 10 Call Tbll-Free Outside California 800 533-5640 Inside California 800 533-5641 FAX (213)625 1850 Local Telephone (213)625-7615 fU .,,, 606 S. Olive Street, Suite 307, Los Angeles, Calif. 90014-9976 P O U COURT RtrORTEKS C.ruf;J 1| A No. They are distinctly unusual in someone 2 j who is a nonsmoker, and one immediately searches for I 3 ! a cause. Q And did you get a history from Mr. Smith in 5 which he indicated that between the years 1970 and 1974, 6 according to him, he had been in an environment in which 7 he had been exposed directly to vinyl chloride, vinyl 8 chloride in regards to it as both a liquid and mist 9 or spray-type situation on a fairly consistent basis 10 throughout those years? 11 MR. CARLSON: Objection. Lack of 12 foundation, incomplete hypothetical. 13 Q [By Mr. Unglesby] Go ahead. 14 A Yes. He gave me quite a detailed history 15 of loading barges and ships with vinyl chloride while he 16 worked for Dow in which he directed a six-inch tube or 17 pipe over and into tank compartments and ran liquid vinyl 18 chloride into these, and also bleeding off the vapors and 19 adding antioxidants when this loading was finished, and 20 that he did three or four barges and up to five ships 21 a week without any respiratory protection in terms of 22 an air supply or even a chemical mask. 23 Q Now, Dr. Kilburn, can you tell us wheth r 24 from your experience in occupational medicine and 25 pulmonology you are aware of any studies or medical QUORUM WortdwKle Teleconferencing m our offices. Computer transcription. Videotaping. Key Word and Phrase Indexing. SUBPOENA SERVICE I* BaronDataIBM ASCII DfeMtlm. Pag* linag* or Arncm DISCOVERY ZX Onktnn: 5V. or 3Vi Data Dynamics Corporation 80606 11 Call Tbll-Free Outside California 800 533-5640 Inside California 800 533-5641 FAX 1213)625-1850 Local Telephone (213)625 7615 1 cause-and effect opinions as to the exposure of an 2 individual to vinyl chloride and the lung or small 3 airways dysfunction that you observed in Mr. Smith? 4 A Yes. There is literature -- Perhaps 5 the best paper directed right at the topic comes from 6 Dr. A1 Miller at Mount Sinai and was published in the 2>v ,,uia,, 1'U,u> 7 Annals of the New York Academy of Sciences -- I think it 8 was 1976 -- I can check the date -- in which they studied 9 a group of vinyl chloride workers and found small airways I 10 obstructive disease in this group of workers. 11 Q Now, the small airways obstructive disease 606 S. Olive Street, Suite 307, Los Angeles, Calif. 90014-9976 POIK COURT REPORTERS U /U 12 that you see in Mr. Smith, can you tell us what kind of 13 day-to-day problems, lifestyle problems, that would create 14 for a person with the same scores, I guess, on the tests 15 as you observed with him? 16 A Well, it interferes with the ease with 17 which one breathes, so we see an increase in the work of 18 breathing such that when there is a need for additional 19 respiration with even mild or moderate exercise, the work 20 of breathing may become excessive, so the person can't 21 perform even modest exercise such as going up a flight 22 of stairs. 23 Q Now, would the findings you see on 24 Mr. Smith that reflect a small airways dysfunction be 25 consistent with his history of exposure in terms of both C QUORUM WorVfwx* Ifeteconferencmg tn our offices. Computer transcription. Videotaping Key Word and Phrase indexing. SUBPOENA SERVICE p BaronData,IBM ASCII Dofcaatt. Pag* imaga or Amcus. DISCOVERY ZX OakatMs: 5V. of 3V, Data Dynamics Corporation POLK COURT REPORTERS C.rufiJ Zb,ponon 80006 12 Call Tbll-Free Outside California 800 533-5640 Inside California 800 533-5641 FAX (213)625-1850 Local Telephone (213)625 7615 1 the type and the extent of the diminished capacity? 2 MR. CARLSON: Objection. Lacks foundation. 3 A Yes. There seems to be no apparent 4 recovery, as far as the studies show us, from vinyl 5 chloride-induced breathing impairment of this sort, so 6 that once it is induced, it is permanent; may even get 7 worse. 8 Q [By Mr. Unglesby] Well, that was my next 9 question. Do you have any predictions or opinions as to 10 whether it would be expected to do so, taken into account 11 that it is now probably sixteen to seventeen years since 12 his gross exposure has occurred? 13 A Well, I think it's probable that it will 14 get worse, as that is the course of small airways diseas 15 in people who have it induced, for example, by asbestos 16 or by cotton dust or by other specific exposures, even 17 chlorine or nitrogen dioxide, so the general effect is 18 that if the small airways become scarred, the scarring 19 continues to worsen over time. 20 Q Dr. Kilburn, is there anything that can be 21 done to reverse the process in regards to Mr. Smith? 22 A No. We haven't been clever enough to undo 23 small airways scarring, even in the disease asthma, which 24 has a large component of small airways disease. That is 25 the component that doesn't seem to be reversible, even 606 S. Olive Street, Suite 307, Los Angeles, Calif. 90014-9976 QUORUM Worldwide Teleconferencing m our orttc*. Computer transcription. Videotaping Key Word and Phrase Indexing. SUBPOENA SERVICE IBM ASCII OcUWflM. Pag* Imag* or Amieua. P BaronData,DISCOVERY ZX Dnkanss; 5v, or 3'Y Data Dynamics Corporation $0006, 13 Call Tbll-Free Outside California 800 533-5640 Inside California 800 533-5641 FAX (213)625-1850 Local Telephone (213)625 7615 1 with exceptional close attention to treating every sort 2 of -- every possible avenue, improving bronchial dilation, 3 i getting rid of secretions, even providing anti-inflammatory 4 treatment. Nothing really seems to avail in this 5 situation. 6 Q Doctor, are you aware of any studies that 7 implicate vinyl chloride monomer with cancer? 8 A Yes. 9 Q Can you answer -- Specifically what I'm 10 talking about here is -- Well, let me ask you: What kind 11 of cancer? 606 a Olive Street, Suite 307, Los Angeles, Calif. 90014-9976 ROW COURT REPORTERS C.rufuJ 12 MR. CARLSON: I am going to object to this 13 line of questioning as irrelevant. 14 Q [By Mr. Unglesby] Okay. You can go ahead. 15 Mr. Carlson is from California. He doesn't know what th 16 case is about or Louisiana law, so he has to make all 17 these objections. 18 Will you tell us -- 19 MR. CARLSON: Well, Mr. Oglesby -- 20 MR. UNGLESBY: Unglesby. 21 MR. CARLSON: I am familiar with the case, 22 and I do have a right to raise objections on behalf of 23 my client, and my recommendation is that if I make an 24 objection, we just proceed and make it for the record -- 25 C MR. UNGLESBY: Okay. OUOftUM WortgwOg Ifttconttrvncing m ogf offices. Computer tranecnptiOfi. Videotaping. Key Word and Phrase index>09. SUBPOENA SERVICE * BaronDataIBM ASCII OflMiiWi Pag* Imag* or Ameu*. DISCOVERY U Owlun**: Sv. of 3v, Data Dynamics Corporation / 8p006 14 Call Tbll-Free Outside California 800 533-5640 * Inside California 800 533-5641 FAX (213)625-1850 Local 'telephone (213)625 7615 606 S. Olive Street, Suite 307, Los Angeles, Calif. 90014-9976 POLK COURT RIPORTtRS C.rufU 1 | MR. CARLSON: -- and we don't waste time. 2: Q [By Mr. Unglesby] The question was: Will 3 you tell us, please, if you know, what studies, what 4 I connections have been raised in the various studies done 5 by Dow Chemical and others in regards to vinyl chloride 6 exposure other than the potential of contracting cancer? 7 A Well, there are a large number of studies 8 from this country done by Monson & Peters, one of them 9 from England, a group of Walker and Wilson and Black, 10 as well as from Germany and now Japan, showing that in 11 workers collected because they share exposure to vinyl 12 chloride monomer there is an increased risk of cancer of 13 the liver, gallbladder, biliary tract, lung, and added 14 into that in some of the cohorts are brain tumors as w 11. 15 Q Now, as to Mr. Smith specifically, first, 16 if we assume for purposes of the question that the facts 17 will show he was exposed to vinyl chloride in the years we 18 have discussed, as he related to you, without the benefit 19 of respiratory protection, and that he has small airways 20 disease, which would, from history, be created by vinyl 21 chloride exposure, and it's now been, again, sixteen 22 or seventeen years since his last gross exposure, can 23 you give us any opinion as to whether Mr. Smith is in 24 increased jeopardy of contracting cancer as opposed to 25 the general population or those unexposed to vinyl l QUORUM Worldwide Teleconferencing in out offices. Computer transcription Videotaping. Key Word and Phrase indexing SUBPOENA SERVICE * BaronDafaI8M ASCII Ctaiwntt, Pag* imag* or Armcu*. DISCOVERY ZX Ookatos; 5V4 or 3'ft Data Dynamics Corporation QQ06 15 Call Tbll-Free Outside California 800 533-5640 Inside California 800 533-5641 FAX (213)625-1850 Local Telephone (213)625-7615 POU COURT RIPORnRS C.,nfiJ Zb.^u.n 7U,,>, 1 chloride in the fashion which he relates? 2 I MR. CARLSON: Objection. Lack of i 3 i foundation, incomplete hypothetical, irrelevant, and 4 assumes facts not in evidence. 5 Q [By Mr. Unglesby] Go ahead. 6 A The likelihood that he will develop 7 epithelial cancer, that is, a cancer of the bile duct, 8 gallbladder, or lung, he is coming to about twenty years 9 after the beginning of exposure, at the period of maximum 10 risk, which will last for a decade or more. 11 For angiosarcoma, the most unequivocally 12 clear tumor caused by vinyl chloride, which is a tumor of 13 the vessels in the liver, it also seems to be -- reach 14 its maximal prevalence sometime after twenty years from 15 beginning exposure, so I would think that from both the 16 epidemiological studies and the anecdotal reports that 17 he is approaching his time of maximal risk in the next 18 decade. 19 Q Is Mr. Smith's potential for contracting 20 any of those diseases you have just related greater than 21 the average individual directly resulting from the fact 22 that he has been exposed to vinyl chloride and that the 23 vinyl chloride has, through the small airways obstruction 24 findings, specifically intruded into and affected his 25 internal organs? i 606 S. Olive Street, Suite 307, Los Angeles, Calif. 90014-9976 QUORUM Worldwide Teleconferencing m our offices Computer transcription. Videotaping Key Word and Phrase indexing. SUBPOENA SERVICE IBM ASCII Dokmm. trruga or Amtcu* DISCOVERY ZX Oijnenw; 5V< or 3V, BaronData Data Dynamics Corporation $0006 16 Call Tbll-Free Outside California 800 533-5640 Inside California 800 533-5641 FAX (213)625-1850 Local Telephone 1213) 625-7615 2>.poution ? U rU, 1 A Yes. 2 Q Do you happen to know, Dr. Kilburn, whether 3 angiosarcoma of the liver created by vinyl chloride 4 exposure or lung cancer created by vinyl chloride exposure 5 are a hundred percent fatal? 6 A Well, the angiosarcomas, there is no 7 question about that; it is rapidly fatal, approximately 8 like a mesothelioma. 9 The lung cancer seems to behave like the 10 general prevalence of lung cancers related to tobacco, 11 smoke, in that if it is discovered very early, the five12 year survival may be as high as 30 percent; if it is 13 discovered by symptoms, which is the usual fashion, the 14 five-year survival is around 8 percent. 15 Q Now, Dr. Kilburn, would you recommend that 16 Mr. Smith, in view of his situation, that he have any 17 particular future medical monitoring? 18 A Yes. He certainly ought to be monitor d at 19 least once a year, and preferably three times a year, for 20 lung cancer. 21 Q That would just involve x-rays? 22 A Yes, basically. 23 Q All right. Sir, what about liver scans? 24 A It is difficult to know whether it would be 25 useful to find an angiosarcoma early, as there doesn't C 606 & Olive Street, Suite 307, Los Angeles, Calif. 90014-9976 POU COURT REPORTERS QUORUM Worttfw** Tetoeontowcwg m our often. Computer transcriptor VtO*ctap*ng. Key Word and Pfwas* irtiat'ng. SUBPOENA SERVICE IBM ASCII OsAMM*. Pag* Imag* or Amcui. P BaronData,DISCOVERY ZX OsAMMs. 5V. or 314 Data Dynamics Corporation POLK COURT REPORTERS C.,nf;J 2)v, 8,0006 17 Call Tbll-Free Outside California 800 533-5640 * Inside California 800 533-5641 FAX (213)625-1850 Local Telephone (213) 625-7613 1 seem to be any possible therapy except the possibility 2 that if it were localized it could be treated by partial 3 hepatectomy, meaning partial removal of the liver. 4 I suppose, with that in mind, trying 5 to find it early by scan would be advantageous, but I 6 know of no experience in that regard, so that is really 7 a recommendation based on probabilities rather than 8 experience. 9 Q All right. Sir, now referring to 10 Mr. Smith's complaints with his memory and his -- 11 A Balance and so forth? 12 Q -- balance and ability to process 13 information, what did you do and how did you do it? 14 A Well, I examined him using a battery of 15 neurobehavioral tests, none of which are original. They 16 are adopted or adapted from batteries that have been put 17 together for examining memory; for example, the Wechsler 18 Memory Scale for scaling intelligence, the Wechsler Adult 19 Intelligence Index, and for measuring responses such 20 as the ability of a person to maintain their position 21 standing, eyes open and eyes closed, balance or sway 22 testing, we have actually built an apparatus to do a t st, 23 which was first described in the nineteenth century and 24 which an apparatus was first devised in the nineteen 25 forties, and, finally, we have used parts of the Halstead 606 S. Olive Street, Suite 307, Los Angeles^ Calif. 90014-9976 QUORUM Worldwide Teleconferencing m our offices Computer transcription. Videotaping. Key Word and Phrase indexing. SUBPOENA SERVICE IBM ASCII Ookrtes. Page Image or Aimeut. DISCOVERY1 ZX DtSkMfes: 5V- or 3Vfc BaronDafa Data Dynamics Corporation ?U,,-,, POLK COURT REPORTERS C*u/tJ 80006, 18 Call Tbll-Free Outside California 800 533-5640 Inside California 800 533-5641 FAX (213)625-1850 Local Telephone (213)625-7615 1 Reitan Battery, which was devised by a neurosurgeon, 2 Ij neuropsychologist at the University of Michigan for 3 i localizing damage in the nervous system by tumors and 4 | infarctions and vascular problems in the days before 5 scanning technology was developed. 6 These tests take about three hours and 7 require a large amount of cooperation by the person being 8 tested. 9 Q And did you apply these tests to Mr. Smith? 10 A Yes. 11 Q Have you previously. Dr. Kilburn, in your 12 studies in occupational medicine used a similar battery of 13 tests to exposed groups? 14 A Yes. 15 Q And has yourtestimony in regard to those 16 tests to those exposed groups been accepted in the court 17 in Louisiana? 18 A Yes, it has. 19 Q Now, Dr.Kilburn, through yourwork in 20 occupational medicine and pulmonology, cancer research 21 and internal medicine, have you gone over -- have you both 22 coordinated with and critiqued the neuropsychological 23 aspects of this case through work with neuropsychologists, 24 psychiatrists, and neurologists? 25 MR. CARLSON: Objection. Vague, ambiguous. 606 S. Olive Street, Suite 307, Los Angeles, Calif. 90014-9976 QUORUM Wortdwid* Teleconferencing m our office*. Computer transcription. Videotaping. Key Word and Phrase indexing. SUBPOENA SERVICE ISM ASCII Diskette* p BaronDataPage Image or Amicus. Ot$CO/RY ZX Dtskattes; $v* or Vh Data Dynamics Corporation 80006, 19 Call Tbll-Free Outside California 800 533-5640 Inside California 800 533 5641 FAX (213)625 1850 Local Telephone (213)625 7615 606 & Olive Street, Suite 307, Los Angeles, Calif. 90014-9976 POLK COURT REPORTERS C.riifuJ 1 lacks foundation. 2 A Yes. 3 Q [By Mr. Unglesby] Have you recently 4 produced a paper in regards to this battery of tests 5 as to its usefulness in screening for neurological or 6 neurobehavioral damages created by toxic exposure? 7 A Yes. Actually, we have just submitted two 8 papers for publication on this topic, as well as having 9 been notified of an additional paper on the measurement 10 of balance and hearing in occupational groups which has 11 been accepted for publication in the British Journal of 12 Industrial Medicine. 13 Q How does one go about getting the British 14 Journal of Industrial Medicine to accept one of their 15 papers and publish it to the medical community in Great 16 Britain? 17 A Well, it's really published to the world 18 medical community. Half the subscribers to that journal 19 are in the United States and about a quarter in Britain 20 and a quarter in the rest of the world. 21 It is done by submitting the paper. It, 22 is then critiqued or reviewed by two reviewers who mak 23 recommendations, and they either recommend publication 24 as is or revisions. In this case -- 25 Q Or they can reject it -- QUORUM Worldwide Teleconferencing >n our offices. Computer transcription. Videotaping. Key Word and Phrase indexing. SUBPOENA SERVICE *> BaronData,IBM ASCH Diskette* Page Image or Amcua. DISCOVERY ZX Diskettes; 5% or 3Vy Data Dynamics Corporation 80006 20 Call Tbll-Free Outside California 800 533-5640 Inside California 800 533 5641 FAX (213)625 1850 Local Telephone (213)625-7615 606 S Olive Street, Suite 307, Los Angeles, Calif. 90014-9976 POIK COURT REPORTERS C.,nfi.J S V ^/,.. 1 A Yes. 2 Q -- as bad science; correct? 3 A Really. In this case, the paper was 4 immediately accepted by Dr. Walton, who is the editor, 5 and it is apparently scheduled for publication sometime 6 this fall. 7 Q And do you know -- Can you tell us the name 8 of that, the name of this paper? 9 A It's "Hearing and Balance." 10 Q Would your CV help any? 11 A Yes, it'.s in there. 12 Q Do you have that here? Is this it? 13 A Here it is, "Hearing and Balance Loss" -14 I'm sorry. Let's start again. "Are Hearing Loss and 15 Balance Dysfunction Linked in Construction Iron Workers," 16 by Kilburn and Warshaw. 17 Q Have you recently made a presentation, to 18 the world health community regarding the use of these 19 tests for the identification of exposure to toxic 20 chemicals such as vinyl chloride and solvents? 21 A Yes. 22 Q And where was that, sir? 23 A It was at the University of Tokyo in Japan, 24 the 8th through the 11th of July, 1991. 25 Q And what types of people would attend such C QUORUM WoiMwiiM Teleconferencing m om tjrtieaa. Comoot*, trantenpten. Videotaping. Key Wtxd and Pnreae indenng. SUBPOENA SERVICE IBM ASCII Dnk&tm. Pag* Imag* or AimoA P BaronOataDISCOVERY ZX Otskfftt* S'A or 3v* Data Dynamics Corporation 8 0*0 0 6 21 x in xdo M o x =2 -_nS3), x x cn X sss. *2 3in 8 cn 39 a seminar? A It consists of people in the occupational health area who are interested in neurobehavioral toxicology. The conference is actually called "Neurobehavioral Methods of Effect in Environmental and Occupational Disease," so the attendees include neurologists, psychologists, and people like myself trained in internal medicine who have used the test batteries, and people, some of whom are not trained ! *co10 in medicine but are psychologists, either trained in. c |R Jll neurophysiology or neuropsychology. 15 12 $ ! 13 It is a meeting of representatives of thirty-three nations, six of the plan -- not planets ic CFO<JDs-> 14 but -- U5 315 Q Continents? CO U 0S011U6 03 17 <0b)o iS 73 ig aj 3 119 oO 20 A -- continents of the world, and about 250 people altogether. Q In the presentation of that paper -- Well, in order to be allowed to present such a paper as that to that kind of a group. Dr. Kilburn, did the standard c3n^21 ** E- = 22 cn o 23 o </5 24 x 25 scientific community have to accept your methodology? MR. CARLSON: Objection. Vague and ambiguous. Lacks foundation. Q [By Mr. Unglesby] That probably is a bad question. OuORUM vuoriftnte Tetocon*erencmg m our office* Computer (rarecnpnon. Videotaping Key Word and Phrase Indexing. SUBPOENA SERVICE * BaronDataIBM ascii Down**. zxPag* imaga or Armcu*. disccweFry Dawns*; sv. w 3y, Data Dynamics Corporation ' 80006 >> . * * 22 l ii What I am asking is this: In order to be r~ iS2 j able to make this presentation to the various physicians 3 and students of occupational medicine around the world, 2x a*. p>W -= s-s 5 33 j* 4 5 6 did the battery of tests and their benefits in identifying neurobehavioral dysfunction created by exposure to toxic chemicals have to be critiqued and discussed and accepted 7 by the consensus of those medical doctors? r 0 CCtCuOOOOp 8 MR. CARLSON: Objection. Vague and ambiguous, compound, calls for speculation. s 0010 r .'52 |n Q [By Mr. Unglesby] Now you can answer. A Well, originally, on notification of the * 13 ^ 12 upcoming meeting, we were asked to submit abstracts. I V. -$ <0 113 did so for the three papers that I mentioned, and another r one on the blink reflex. {2 All of the abstracts were accepted for presentation, and then in the development of the program & I was asked to chair the session on environmental studies, 8 c which included methyl mercury in Minimata Bay, it's in southern Japan, and some exposures in Germany and Canada and China as well as in the United States, and I mentioned Japan, and then they asked me to select, of the two papers which I presented on this, I was to present on this G subject the one that I would prefer to put in this plenary session, and I selected one on toxic waste exposure of a population in Louisiana, and it was presented. OUORUM WoridwuM Teteconfwwcmg in our otficM. CKoymWpuonti)r atrnaanKPrhioratiao*n-InVaIaOnainogra.ping. SUBPOENA SERVICE IPDBaIMSgCeAOISmVCEaIgRIaOTotZHrXaAnOmtosc.um*o. m; S'a or 3'A BaronData, Data Dynamics Corporation j? 8, 0' 1006 23 Call Tbll-FVee Outside California 800 533-5640 Inside California 800 533-5641 FAX (213)625 1850 Local Ifelephone (213) 623 7615 1 Q Now, these various tests, as they relate to 2 Glen Smith, what did they tell us specifically as to him? 3 A Well, what they did was profile, in 4 a sense, the types and severity of impairment; and, first 5 of all, he had reduction in his performance for verbal and ! i 6 visual recall of information. These are generally called j ?U,,-,, 7 immediate memory tests. 8 In contrast, he had no effect with what 9 we would call crystallized memory tests. These tests 10 test information learned in school or learned years ago 11 and tend to be in the areas that don't deteriorate from 606 S. Olive Street, Suite 307, Los Angeles, Calif. 90014-9976 ROWCOURT REPORTERS C.rufuJ 12 chemical exposure, as compared to the ability to encode 13 and recall new information. 14 He also had poor motor perceptual decision 15 making commands in that he was slow in constructing 16 designs, seeing, actually, relationships between designs, 17 and in even being able to manipulate his hands with either 18 pencil or without pencil, to make decisions and carry out 19 operations, like putting a slotted peg in a pegboard, or 20 following numbers, drawing connecting lines to make trails 21 between numbers or between numbers and letters. 22 All of this has probably more to do with 23 the decision-making capacity of the brain than it does 24 with how well his fingers operate. 25 C He also had some defect in perception on QUORUM worldwide Teleconferencing m our offices Computer transcription. Videotaping. Key Word and Phrase indexing. SUBPOENA SERVICE ISM ASCII Diskettes. Page Image or Amicus. P BaronOataDISCOVERY ZX Diskettes. Sv. or 3V* Data Dynamics Corporation **. 8t 0* 0* 06 24 Call Tbll-Free Outside California 800 533-5640 Inside California 800 533-5641 FAX (213)625 1850 Local Telephone (213) 625-7615 POU COURT REPORTERS C.rn(uJ 2)v sii. , ,, % / ,, ,, 1 his right hand that I think reflects localized effects of 2 vinyl chloride on the peripheral nerves -3 MR. CARLSON: Excuse me, Doctor. Are you 4 referring to Table 2 of your report? 5 THE WITNESS: Yes. 6 A [Continuing] And he had a delayed choice 7 reaction time with a normal simple reaction time. 8 This, again, when he has to make decisions 9 then his decision-making capacity is present, but it is 10 slowed down, so it -- He made decisions at an average 11 of about .68 of a second instead of around .5, or half 12 a second, where he should have. 13 All of these, I think, reflect the effect 14 of chemical exposure on the brain, and in this case most 15 likely vinyl chloride, because that is what he was heavily 16 exposed to. 17 MR. CARLSON: For purposes of the record, 18 I would move to strike the doctor's answer based upon 19 the fact that his testimony was pertaining to Table 2 20 Neurobehavioral Tests; is speculative. 21 Q [By Mr. Unglesby] Dr. Kilburn, let's 22 answer that, if we may. 23 What scientific medical basis do you use 24 in making these comparisons? And in Table 2 it does 25 relate -- and we will attach all this -- to a comparison 606 S. Olive Street, Suite 307, Las Angeles* Calif. 90014-9976 QUORUM Worldwide Wocontowfletng m our office* Computer transcription Videotaping. Key Word and Phraee Indexing. SUBPOENA SERVICE * BaronDataISM ASCII Oaken**. Pege Image w Anwu*. discovery zx D*k*n; sv, ,, 3^ Data Dynamics Corporation 8Q006, 25 Call Tbll-Free Outside California 800 533-5640 Inside California 800 533-5641 FAX (213)625-1850 Local Telephone (213)625-7615 606 a Olive Street, Suite 307, Los Angeles, Calif. 90014-9976 rout COURT RtPORTtRS C^uftJ a , ,,/,,,r 11 | of Mr. Smith with fourteen control firemen. What do you 2 | mean by that? 3 j A Well, it is always important to make 4 comparisons of a population or an individual to a group 5 who are in as many ways similar to the individual or group 6 but lack the specific exposure or any exposure that might 7 have an adverse effect on their neurobehavioral function. 8 In this case, controls were selected in 9 Louisiana; the comparison population for firemen who had 10 been exposed to a fire in which transformers containing 11 PCBs and benzofurans were overheated by the fire and then 12 exploded, such as to spread the chemical around. 13 In order to analyze that population, we had 14 the fire chief pick matches for the exposed men, and we 15 tested them at the same time -- 16 Q You mean what you had is a control group 17 that was unexposed? 18 A Yes. These were firemen who didn't even 19 respond to that fire. 20 Q Okay. 21 A And this gave us, then, a statistical base 22 in fourteen people for establishing what their mean 23 performance is and what the confidence intervals are, 24 upper and lower limits for the performance, and what are 25 marked as pluses after Mr. Smith, who, as indicated on QUORUM Worldwide Teleconferencing m our offices Computer transcription Videotaping Key word and Phrase Indexing. SUBPOENA SERVICE BaronOataIBM ASCII OtskMWl Pag* Inug* or Amicu*. WSCCVERV ZX Otslwtlm: 5V or 3'0 II Data Dynamics Corporation row COURT REPORTERS C.m(uJ 8O0O6 26 Call Tbll-Free Outside California 800 533-5640 Inside California 800 533-5641 FAX (213)625-1850 Local Telephone (213)625 7615 1 this table as LS, the pluses indicate where his test 2 results were outside the 95 percent confidence interval. 3 This is very similar to what we do in 4 pulmonary function when we say that, well, his vital 5 capacity and FEV-1 were outside the 95 percent confidence 6 intervals for the population which we compared him against 7 for pulmonary function, which happens to be a population 8 recruited in the State of Michigan to represent Michigan 9 people as a microcosm or sample of the United States 10 population. We sampled a proportionate number of urban 11 and rural men and women in Michigan to represent the 12 population. 13 Q And that is the standard used all over the 14 United States? 15 A Yes. This is a standard way of going about 16 creating from tests results statistical limits that -17 against which one can make the comparisons of -- as I say, 18 either an individual or a group of people. 19 Q And so the reason you used the fourteen 20 control firemen from Louisiana was because you knew that 21 those were fourteen people done in a separate study who 22 had not been exposed to vinyl chloride or to any other 23 sequential solvents' exposure and had specifically been 24 screened to make sure that they hadn't been exposed and 25 represented people who all had at least a high school 606 a Olive Street, Suite 307, Los Angeles, Calif. 90014-9976 QUORUM WorttwiO* Teleconferencing m our offices Computer transcription. Videotaping. Key Word and Phrase Indexing. SUBPOENA SERVICE IBM ASCII OokMM. Pag* Imag* or Ameua. P BaronDataDISCOVERT ZX Dukmm; 5v. or Vh Data Dynamics Corporation ' 8 0 O'O 6 27 Call Tbll Free Outside California 800 533-5640 Inside California 800 533-5641 FAX (213)625-1850 Local Telephone (213)625 7615 2>v ,,ui.n 606 S. Olive Street, Suite 307, Los Angeles, Calif. 90014-9976 POLK COURT REPORTERS 1 education and had come from backgrounds similar to that 2 It of Hr. Smith? l 3! A Yes. 4 | Q You already had all that information before 5 you ever heard of Glen Smith? 6 MR. CARLSON: Objection. Vague, overbroad, 7 lacks foundation. 8 Q [By Mr. Unglesby] You had all of that in v 9 your study before you ever heard of Glen Smith; correct? 10 A ' Yes. 11 Q And so you felt that that was a good 12 comparison to use, since these people had taken all of 13 these same tests and you knew their historical back 14 ground and educational background, and you knew Smith's 15 historical background and educational background, at least 16 as he relayed it to you? 17 A That's correct. And, furthermore, this 18 data has been published, so it is available to everyon 19 in the literature. 20 Q And if Mr. Carlson wanted to look that up, 21 how would he do that. Doctor? 22 A Well, my CV would be helpful, too. 23 The paper is No. 158 in my CV, by Kilburn, Warshaw 24 and Shields, "Possible Improvement in Neurobehavioral 25 Function following Detoxification of Firemen Exposed to QUORUM Worldwide Teleconferencing <n our offices. Computer transcription. Videotaping. Key Word and Phrase Indexing. SUBPOENA SERVICE * BaronData.IBM ASCII Diskettes. Page image or Amicus. DISCOVERY ZX Diskettes; 5% or 3 Data Dynamics Corporation 80006 28 1 Polychlorinated Biphenyls," Archives of Environmental C7 ub Health, 1989, Volume 44, Pages 345 to 350. M 3 -O aS A 4 a5. c>m0 5 * ^ 02 j* 6 Q And, specifically, the usefulness in regard to this case was not to the exposed group but to the nonexposed group and comparing them with Glen? A That's correct. What was used was the 7 control side of a matched control group comparison study. r _5 3up 8 Q Okay. In doing that, what final eemnn 9 conclusions did you draw in relationship to Glen Smith? r -01 <4" "10 .2 MR. CARLSON: Objection. Foundation, !u 73 v 12 T3 S13 speculation. A Well, in review of what he has -- Just to mention it again, he has reduction in his recent recall ( memory, a reduction in cognitive function as measured in culture fair, f-a-i-r, and block design, a loss of eye-hand coordination as measured in pegboard trails and C choice reaction time, and I believe these defects are most consistent with a substantial exposure to vinyl chloride and to other solvents that he was exposed to over his C whole career. I think the most predominant exposure out of those is to vinyl chloride. ( Q [By Mr. Unglesby] You are basing that on o 24 the history that he provided you as far as the exposur ? 8<0 25 A Yes. ( QUORUM Worldwide Teleconferencing ,n ^ office Compute* transcription Videotaping Key Word and Phrase Indexing SUBPOENA SERVICE IBM ASCII Oaken**. p BaronDafaPage image or Amicus. DISCOVERY ZX Diskette*. 5% or 3'/* Data Dynamics Corporation 80006, 29 Call Tbll-Free Outside California 800 533-5640 Inside California 800 533-5641 FAX (213*625 1850 Local Telephone (213*625 7615 1 | Q But the tests are consistent with a 2! diminished brain function that has been found in people 3 I exposed to toxics such as vinyl chloride over years? i 4 | A That's right, yes. 5 MR. UNGLESBY: Now, I will attach this -- 6 By the way, I am going to attach these three as Smith's 2. 7 I think that is the three you were asking about. 8 MR. CARLSON: Yes. 9 MR. UNGLESBY: Okay. 10 [Lloyd Glen Smith Exhibit 2 11 was marked for identification.] 606 Sl Olive Street, Suite 307, Los Angeles, Calif. 90014-9976 POIK COURT REPORTERS C.r4 ,, l 12 Q [By Mr. Unglesby] And while X am on that 13 subject, Dr. Kilburn, the last page of Smith 2 refers to 14 comparisons, again, with the fourteen men that we hav 15 discussed and has some numbers out there for Lloyd Smith, 16 9, 8, 7, 12, 1, 4, and 17 total P-O-M-S score. 17 What does the P-O-M-S stand for? 18 A Profile of Mood States. 19 Q Okay. 20 A This is a test used to appraise effective 21 condition, you might say emotional status of an individual, 22 and what we see is that this is not an upset and angry, 23 depressed, fatigued or confused man. He is -- actually 24 has a POMS score that is normal. 25 Q The normality of that score, Iappreciate t QUORUM Worldwide Teleconferencing m our offices Computer transcription Videotaping Key Word and Phrase Indexing. subpoena service * BaronDataIBM ASCII Dwuxm Pg Inug* of Amo*. DISCOVERY ZX Ooktttm: SV, or 3vt Data Dynamics Corporation fU ,,,, ,8.0006 30 Call Tbll-Free Outside California 800 533-5640 Inside California 800 533-5641 FAX (213)625 1850 Local Telephone (213)625 7615 606 S. Olive Street, Suite 307, Los Angeles, Calif. 90014-9976 POLK COURT REPORTERS C.rufi.J the chart enables you to disregard the idea that any of 2! the tests on Table 2, which are more of the neuro3 j behavioral tests or results, or the results are skewed 4 | by any emotional dysfunction or disease that Glen may 5 have; is that correct? 6 A Yes, that is the inference that can be, I 7 think, safely made from the evidence, that he has normal 8 scores. 9 Q So psychiatrically or emotionally he is 10 a healthy person? 11 A Yes, that's what the testing says for 12 June 20, 1989, and the week preceding, which is the way 13 that test is given. 14 Q And he appeared to be in his relationship 15 with you appropriate in those regards? 16 A Yes. I should have mentioned that, but I 17 made a note of it in the letter, and it is part of the 18 report that not only did he seem pleasant and appropriate 19 but he seemed fully cooperative with all parts of the 20 examination and testing. 21 Q So then we have on Page 2 of Smith 2 -22 and I will go ahead and just write 1, 2, 3 on these pages; 23 1 would be the list of tests you gave, 2 would be the test 24 scores and results, and 3 would be the mental status exam 25 in terms of psychiatric profile. i i QUORUM woridwxj* lbtecontonncing in our often. Comouier transenpuon, ViOooMpmg, Key Worn am) PPrsa* morning, SUBPOENA SERVICE IBM ASCII Dttkem Pag* Imago or Amen. P BaronData,DISCOVERY ZX Dakenw $'/. 3-y Data Dynamics Corporation 80006 31 Call Tbll Free Outside California 800 533-5640 Inside California 800 533-5641 FAX (213)625-1850 Local 'lLlephone (213>6267615 2>v ,oiio,, f i o(ur!ei 606 S. Olive Street, Suite 307, Los Angeles, Calif. 90014-9976 COURTrow REPORTERS 1 It is on Page 2 that Glen reflects the out2 of-balance problems indicating neurological dysfunction; 3 correct? 4 A Yes. 5 Q And that is in your mind, I mean from your 6 studies and in the literature, consistent with vinyl 7 chloride exposure? 8 MR- CARLSON: Objection. Foundation, 9 speculation. 10 A Yes. 11 Q [By Mr. Unglesby] If you can tell us, 12 Dr. Kilburn, is this a reversible situation? 13 MR. CARLSON: Same objection. 14 A My experience -- and when this is due to 15 exposure to chemicals, with the exception of ethyl alcohol 16 or ordinary beer, wine, and whiskey alcohol, the answer is 17 no. That is the only chemical that has widely been shown 18 to have reversibility. 19 There is some evidence that xylene and 20 toluene, benzene derivatives, are reversible for some of 21 these tests by doing exposure of subjects; but by and 22 large the experience has been with occupational exposure 23 these tests revealed irreversible changes, and this has 24 been established by retesting individuals at intervals 25 after exposure and finding that in most cases once down. QUORUM Worldwide Telecontertnang tn our offices. Computer transcription VdecWpmg. Key Word and Phrase Indexing. SUBPOENA SERVICE * BaronDataIBM ASCII Dolan**. Pag* Intag* or Amo* OISCCVERV ZX Dakin**. Sv, or y/, Data Dynamics Corporation 80006 32 Call Tbll-Pree Outside California 800 533-5640 Inside California 800 533-5641 FAX (2131625-1850 Local Telephone (213) 625 7615 fU ,,,, 606 S. Olive Street, Suite 307, Los Angeles, Calif. 90014-9976 POIK COURT RfPORTCRS C.ruf.J 1 they stay down, or once deficient, they stay deficient. 2 Q [By Mr. Unglesby] In regard to the 3 findings on Page 2 of Smith 2, do you have any -- do 4 you give any information or opinion as to what these 5 deficiencies -- how these deficiencies would affect 6 a person 41 years old such as Glen and -7 MR. CARLSON: Objection -- 8 Q [By Mr. Unglesby] -- and whether or not it 9 is anticipated that you would find this in a person with 10 Glen's historical background absent the vinyl chloride 11 exposure? 12 MR. CARLSON: Objection. Foundation and 13 speculation. 14 A They are a pattern that would not be 15 anticipated in a person without exposure to some toxic -- 16 neurotoxic material. 17 Furthermore, they are in a pattern -- What 18 was the first part of your question? 19 Q [By Mr. Unglesby] Well, why don't you -- 20 Are you finished with that answer in terms of the 21 patterns? 22 A Yes, I am. 23 Q All right. Then I wanted to know whether 24 or not if you could tell us what results like these 25 reflect in a person's daily life or ability to do or QUORUM worldwide Tencontorancing m out ottcvs. Computer transcription Videotaping. Key Word and Phrase Indexing. SUBPOENA SERVICE BaronDataIBM ASCII Diskettes. Page Image or Amicus. DISCOVERY ZX Diskettes; 5V* or 3V* Data Dynamics Corporation 8Q006, 33 lO not do any particular tasks or a chore. t3r iA A Well, it would be mostly reflected in 3co trying to do intellectually, perform anything from o c ^JDS3Jj. C&2*^7AJ fS 2 4 remembering telephone numbers to remembering conversations so that he could make choices. That is on the memory 13 a X side. * w On the making choices, mental cognitive c a 3trp function side, he is going to be slow; and, you know, if ccinoo he were doing things like some of my patients, assembling o S' "CQ10 automatic transmissions, he would not be able to follow f (R 'g I11 through a sequence of procedures because he couldn't 13 u0> 12 remember what came after what and couldn't see the logic 13 <0 113 of the whole thing, or if he was, for instance, a loan C <x> sS 214 officer in a bank, he couldn't recall what decision he m 3 gi5 had made recently about loans and would therefore show e Io*"0s3 050 16 inconsistency in performance. Sf I17 MR. CARLSON: That's a problem they all *3 It: |18 have. a Jll9 THE WITNESS: That's at a very low level in Sc t-* A3 S20 banks. I haven't had patients that are BCCI executives. J,! 3 ^ 21 2? They might be interesting to test, as a matter of fact. 1=5 22 $50 Q [By Mr. Unglesby] From the scores, if you f I > 23 could tell, would Mr. Smith have a difficult time, for O ai 24 example, working in a plant such as Dow doing control-type s<os 25 work, in other words, inside with a board, computer board, f l* QUORUM Worldwide Teleconferencing m our office* Computer transcnpton. Videotaping Key Wor<3 and Phrase indexing. SUBPOENA SERVICE IBM ASCII Oofcenm, Page image or Amcua. P BaronData.DISCO/ERV ZX Daxenes. 5Vi or 3'ii Data dynamics Corporation ,80006 34 or control board, that required him to get -- check gauges, record information and monitor and alter certain activities in the plant as it related to whatever shows up on those various boards in terms of -- you know, in terms of what they do in places such as Dow? a MR. CARLSON: Objection. Foundation, speculation. r 8 A Well, I think, you know, that's an example. I was thinking of another that's similar, and that is running the -- oh, what do you call them? -- the gates r .oil on the Tennessee Valley dams, but in any process control operation where you have to remember sequences and make J13 decisions based on reading dials he is going to be slow c to a s i4 and I think have trouble, because he may leave out, you a 5s 5O i<fi^"9 15 know, one important step in a sequence and thus mess up; 6 -816 so I think that he is excludable from that kind of ( employment. Q [By Mr. Unglesby] All right. But is it a fair statement that, in your opinion, at least, and c 20 based on these tests and historical information you have 221 been provided by Glen as to vinyl chloride exposures and the way that has been provided to you that in fact reflect t that neurologically he has been damaged so that his mental 24 capacity is diminished below what would be expected of th 25 normal 41-year-old? ' QUORUM Worldwide Teleconferencing m our offices, Computer trargenpton. videotaping. Key Word and Phrase indexing. SUBPOENA SERVICE e BaronOataIBM ASCII Diskette* Page Image or Ament. DISCOVERY ZX Diskettes; 5% or 3V? Data Dynamics Corporation 80'006* 35 Call TbllFree Outside California 800 533-5640 Inside California 800 533-5641 FAX (213)625-1850 Local Telephone (213)620 7615 606 a Olive Street, Suite 307, Los Angeles, Calif. 90014-9976 POU COURT REPORTERS C.riifi.J 1 MR. CARLSON: Objection. Foundation and 2 speculation. 3 A Yes. I think the test evidence establishes 4 that clearly. 5 MR. UNGLESBY: All right. I will introduce 6 this as Smith 2. 7 Q [By Mr. Unglesby] And that is, in your 8 opinion, irreversible, and something that does have 9 a specific day-to-day effect on his capacity to sequence 10 information, remember things and make cognitive judgments 11 and differentiate and discriminate between the daily 12 activities that are necessary in the modern world? 13 MR. CARLSON: Objection. Foundation and 14 speculation. 15 A Yes. 16 Q [By Mr. Unglesby] All right. Finally, 17 Dr. Kilburn, in your report you reflect upon the fact that 18 Glen has very severe arthritis and had observed in some 19 x-rays that you took in 1989 that he might have specific 20 abnormalities unique to vinyl chloride exposure in his 21 hands; is that what you said then? 22 A Yes, it is. 23 Q Subsequent to that have you been provided 24 with some additional x-ray reports from 1986 and *87 taken 25 by Oschner, 0-s-c-h-n-e-r, Clinic in New Orleans and some QUORUM Woridwide TWeconferencmg in our office*. Computer transcription Videotaping. Key Word and Phrase Indexing. SUBPOENA SERVICE BaronData,IBM ASCII OMttm Pagt tm*g* or tncui DISCOVERY ZX OaAtatt: 5v, or )/, Data Dynamics Corporation 8CT006 36 1 i 1991 films taken in Baton Rouge? <[>e lcONo 2 A Yes, I have. 2 eu om O '7' -_SQ0). ?^tos5j 3 5 Q Have you compared all of those? A Yes. Q Is it now your opinion that he suffers "s 3 jJj * V from the specific -- I'm going to spell this for you -a-c-r-o-o-s-t-e-o-l-y-s-i-s, acro-osteolysis? r _o 3iO 8 The question was: After you reviewed all CCOO of these films, do you think he has got that? r 9 > =10 .'S2 |U A No. Q And do you think -- Do you have any opinion "12 -S -- Let me read this to you. It's been said by Dr. -- 'ai3 MR. CARLSON: Shucks, I just spent eight C hours preparing cross-examination on that. MR. UNGLESBY: I apologize. I mean, I really do. c Okay. I didn't know the answer to that until I looked at all the films either. Q [By Mr. Unglesby] It has been said c by Dr. Rosenberg at Oschner's that it is possible, theoretically, that vinyl chloride has affected Glen's cn OCO t 23 o erf 24 3co 25 condition based on the idea that a virus or environmental factor can damage tissue around a joint, creating an immune system response which doesn't stop, so that th immune system keeps going back and going back after the QUORUM WortftndC THeconlerencmg m our office*. Computer transcription Vfcteotapmg. Key Word and Phrase Indexing. SUBPOENA SERVICE IBM ASCII Diskette*. Pag* Image or Aithcu*. DISCOVERY ZX Diskette*. 5% or 3'4 BaronData, Data Dynamics Corporation 80006- 37 Call Tbll-Free Outside California 800 533-5640 Inside California 800 533-5641 * FAX (213)625-1850 Local Telephone (213)626 7615 ROWCOURT REPORTERS CU/uJ 2 V - /- * fU ru , 606 S. Olive Street, Suite 307, Los Angeles; Calif. 90014-9976 1 damaged tissue, even though the environmental factor has 2 ! now been removed. I i 3! He refers to that as a theoretical 4 | possibility for an explanation as to Glen's acute 5 arthritis. 6 Do you agree or disagree that that is 7 a possibility? 8 MR. CARLSON: I would object. It 9 mischaracterizes Dr. Rosenberg's testimony and lacks 10 foundation and is speculative. 11 Q [By Mr. Unglesby] Go ahead. 12 A Well, I think that we are presented with a 13 man who has a very severe arthritis variant sero-negative 14 with joint changes in a pattern that resembles what is 15 commonly called rheumatoid arthritis, and as rheumatoid 16 arthritis is a disease we don't understand what its causes 17 are except that it is inflammatory and it seems to have 18 followed his, as Dr. Rosenberg points out, infections, 19 at times, trauma, chemical exposure, that it is quite 20 conceivable that to explain the latent period between his 21 large-scale vinyl chloride exposure, which is known to 22 damage vessels, cause immune complexes to lodge in vessels 23 and to thereby interfere with crucial places where 24 vascular supply is important, like the articular surfaces 25 of joints, that it is not at all unreasonable to conceive QUORUM Worldwide lileeonlerencing m our often. Computer transenpuon. videotaping Key word and Phrase indexing. SUBPOENA SERVICE * BaronDataIBM ASCII DtskAIM, Pag* Imag* or Ajmcu*. DISCOVERY ZX Dukinn; 5Vk or 3>4 Data Dynamics Corporation 8.0006 38 I--M that his arthritis had its initiation by vinyl chloride. X o Q In fairness to you, however, is it correct 'X --o oc2!<X5> -0S>- ^ C) CO 1S5 S 5x as 4 5 6 7 that there are no epidemiological studies nor any literature studies that you have observed nor patients that you have previously observed that have been able to directly link the exposure to the arthritic disease? A That's true, and, again, in fairness, r <?** s19 8 there seems to have been no published records, at least, ccinoo follow-up of the people who had the more characteristic -> I- fl 00 10 `s2 tpfell Raynaud's phenomenon, reabsorption of distal phalanges and erosive sclerosis of the sacroiliac joint which are' S3 ^12 T<3L) ai3 typically signs of the vinyl chloride monomer-induced connective tissue disorder, so this really is a place r <> */* O 14 where we lack the evidence, because the evidence has not 9't slO |s15 been looked for. ^ 8 16 It's an answerable question. It's just jJ17c o ro that it has not been answered, so far as I am aware <1> 03 c18 or have been able to find, and apparently so far as < D c s 32119' S. - co o3 20 Dr. Rosenberg was able to find, also. Q So in summing up the question of the Sr C'3O 5--:21 arthritis, would it be correct that we have it is = 22 established in the scientific medical literature that c CUO rul 23 the connection between the vinyl chloride exposure and O c/3 24 cancer can exist; that the connection between vinyl 25 chloride and small airways disease can exist; that the c QUORUM Wortdwde Teleconferencing in our offices. Computer transcription Videotaping. Key Word and Phrase Indexing. SUBPOENA SERVICE IBM ASCII OntaMM* Pag* lm*g* or Anan BaronDataP DISCWERY ZX Dakanos, 5V. or 314 a- BSP Corporation p 0.0 06. 39 C *'tiMno7 ^o c X5 -I ub is f X * 4 5 6 connection between cancer -- I mean -- excuse me -between vinyl chloride exposure and neurological damage can exist; that Glen has been demonstrated to have two of those problems and has, by history, in your hypothesis been exposed, and that within six to seven years of that, of the extent of that gross exposure, developed an 7 additional severe arthritic condition which has not been r *>s 3o 8 linked through medical studies to vinyl chloride exposure? n S3 9 MR. CARLSON: Objection. Foundation; 1* 003010 In 03 u 12 <V ?2 c 13 Of CCO"- 214 m CK S15 O iO 16 50 O SB l|17 1318 j|l9 -3 ^ 20 3$ 3321 vague, overbroad, speculative. Q [By Mr. Unglesby] And that the most you could say about that is that if you look at the complex set of symptoms, it is possible there is a connection, but from a medical perspective you are not prepared to say that it is more likely than not that there is a connection? MR. CARLSON: I apologize for interrupting you. I thought you had completed the question, but I will -- MR. UNGLESBY: That's okay. MR. CARLSON: I will interject the same ai8ss =o22 23 o erf 24 25 objection. Speculation. A I think that summarizes the way I would put it together, having gone back and reviewed with care everything I could find in the literature concerning the QUORUM Worldwide Teleconferencing m our offices. Computer transcription. Videotaping. Key Word and Phrase indexing. SUBPOENA SERVICE * BaronDataIBM ASCII DOOMS. Pigs Imsgt or Amicus. OISCGMEftV ZX OnksitM; 5'/. or 3Vj i Data Dynamics Corporation  80006 40 connective tissue disorder connected to arthritis, that my x Mx opinion now is, as stated, that it is quite conceivable, 'X S but we don't have the evidence on which to base a firm -4) oifl I 2 conclusion the causation is established or the causal r -C 1/i JC)L X relationship has been established. S X r MR. UNGLESBY: Mr. Carlson, I am finished. [Discussion held off the record.] 3iC CO CtoO EXAMINATION C 05010 e BY MR. CARLSON: lu Q Doctor, .are you an expert in the area of -4o> 12 ii3 rheumatology? A Well, I have training for the boards in ( vatt internal medicine and rheumatology, so I don't know quite how to answer you. I'm not a subspecialist rheumatologist. c Q Well, that is what I'm getting at. There 8 c is a subspecialty in rheumatology under the internal medicine boards. A I believe there is. Q And you are not certified as a subspecialist within that area? tA No. o erf 24 Q You are not aneuropsychologist? 25 A No. i QUORUM Wortdwge Teleconferencing m our office*. Computer transcription. Videotaping, Kay Word and Phrase indexing. SUBPOENA SERVICE IBM ASCII Mkattn Pag* Imag* or Ament DISCOVERY ZX DsluttM; 5V. or 3'0 p BaronOata Data Dynamics Corporation 80-006- 41 Call Tbll-Free Outside California 800 533-5640 Inside California 800 533-5641 FAX (213)625-1850 Local Telephone (213)626 7615 %/,,,,,, 606 & Olive Street, Suite 307, Los Angeles, Calif. 90014-9976 POLK COURT REPORTERS C.,ufU 1 j Q There is a separate discipline of I 2 | neuropsychology, is there not? I 3 A Well, there are people who call themselves 4 neuropsychologists. Most of them were trained in 5 psychology. 6 Q They have studied neuropsychology? 7 A Yes. 8 Q Doctor, you are not board-certified in 9 the area of toxicology? 10 A Well, until recently there haven't been 11 boards in toxicology. Whether the board is going to stay 12 alive or not is anybody's guess; but I am not. 13 Q And you have no subspecialty in the area 14 of -- Let me withdraw that. 15 Doctor, the Oschner Clinic, are you 16 familiar with that? 17 A Yes, I am. 18 Q It is in Louisiana? 19 A Yes. 20 Q What is the reputation of that clinic, if 21 you know? 22 A For what? 23 Q For medical evaluation. 24 A Well, it is a large multispecialty clinic. 25 I think they are reasonably reputable. I haven't heard OUORUM Worldwide Ti*contorvnang in Our offices Compeer transcription. Videotaping Key Word and Phrase Indexing. SUBPOENA SERVICE * BaronDataIBM ASCI Diskettes, Page Image or Amicus. DISCOVERY ZX Diskettes; $'/< or 3V7 ___________________ Data Dynamics Corporation 80006, 42 Call Tbll-Free Outside California 800 533 5640 Inside California 800 533-5641 FAX (213)625 1850 Local Telephone (213)625 7615 606 S. Olive Street, Suite 307, Los Angeles, Calif. 90014-9976 POU COURT REPORTERS C.m uJ( 1 anything to the contrary. 2 Q I mean nationwide they have got a good 3 reputation; it is recognized as a leading medical center? 4 A Yes. 5 Q Okay. Now, Doctor, turning to your report, 6 you have seen the plaintiff on one occasion? 7 A Yes. 8 Q And you have had no follow-up with the 9 patient since that time that you met with the patient on 10 June 20, 1989? 11 A That's right. 12 Q How was the patientreferred to you? 13 A From Mr. Unglesby. 14 Q The plaintiff's attorney in this case? 15 A Yes. 16 Q What was thepurpose of theexamination, 17 for evaluation for the lawsuit? < 18 A Well, the purpose was evaluation at that 19 time. I don't know what the status of the lawsuit was. 20 Q Had there been a lawsuit filed? 21 A I don't know. 22 Q And he referred his patient to you -- 23 his client to you for evaluation of the patient's lung 24 condition; is that right? 25 A Well, it was for his lung and other QUORUM WortdwKto Ifetocontervocing *n our offices. Computer transcripttin. Videotaping. Key Word end Phrase indexing. SU6POEMA SERVICE * BaronDataIBM ASCII Dakene*. Page Image Armcu*. DISCOVERY ZX Dofcattaa; 5V, or 3vi Data Dynamics Corporation 80006. 43 Call Tbll-Free Outside California 800 533-5640 Inside California 800 533-5641 FAX (213)625-1850 Local 'Iblephono (213)625-7615 I 1 | conditions that might be occupationally related. 2 1 a Well, I am referring to the first paragraph 3 ! of your report. Doctor, that says, "This patient was seen 4 1 on June 20, 1989, at the Southern California Environmental 5 Medical Clinic at Long Beach to evaluate his lung 6 condition," period. 7 Was that the purpose of the evaluation? 3 A Well, I think that is kind of a pretty 9 standard sentence that we use in the clinic. Sometimes 10 it is not quite appropriate, as there was more involved 11 than just his lung evaluation, as you know. 12 Q Under the Occupational History section 13 there is an indication that he was engaged in his work 14 for Dow for twelve hours a day from 1970 to 1974. 15 Where did you get that information? 16 A From him. 17 Q And he told you that he had worked twelve 18 hours a day filling barges from 1970 to '74? 19 A Well, I would think that was up to twelv 20 hours. I may have -- 21 Q It doesn't say that, though, does it? 22 A No. It says twelve hours. 23 Q And the statement, "He was provided no 24 respiratory protection," where did that information com 25 from? ! i 1 j 606 & Olive Street, Suite 307, Los Angeles, Calif. 90014-9976 POUC COURT REPORTERS QUORUM WofKftwde Tfc**coolfrtcing m our offices Computer transcription. Videotaping. Key word and Phrase indexing. SUBPOENA SERVICE BaronDataIBM ASCII I Pag* Imag* or Ameut DISCOVERY ZX Oifkanm: 5V. o, 3.4 Data Dynamics Corporation POLK COURT REPORTERS U /U 8.Q006, t! 44 Call Tbll-Free Outside California 800 533-5640 Inside California 800 533-5641 FAX <213)625-1850 Local Telephone (213(625-7615 A From him. Q If in fact the situation were such that 3 i respiratory protection was used, would your opinions be 4 any different in this case? 5 A Well, it would depend on what was used. 6 Short of an air supply respirator, no. 7 Q So short of that, if any other type of 8 respiratory protection equipment were used, your opinions 9 would all be the same? 10 A Yes. 11 Q What TLV was the plaintiffexposed to? 12 A All right. That is a nonsense question, as 13 far as I can understand. I don't -- Are you asking for 606 & Olive Street, Suite 307, Los Angeles, Calif. 90014-9976 14 the level of vinyl chloride he was exposed to? Because 15 a TLV is a threshold limit value, and in the context of 16 this question it has no meaning. 17 Q Okay. Let's go back and approach it 18 a different way. 19 Do you have any quantification on his 20 exposure to vinyl chloride monomer? 21 A I know of no measurementsthat were made, 22 if that is what you are trying to ask. 23 Q Isn't it important to know the exposure 24 level of a chemical before a doctor gives an opinion on 25 potential ramifications of exposure? QUORUM worldwide Teleconferencing m our offices Computer transcnpton Videotaping Key Word and Phrase indexing. SU8P06NA SERVICE IBM ASCII Oakeite* Pag* Image or A/mcua. DISCOVERY ZX Down** 5V. <y 3V, BaronData i Corporation 80006- 45 Call Tbll-Free Outside California 800 533-5640 Inside California 800 533-5641 FAX (213)625-1850 Local 'telephone (213) 625-7616 7 U ,,,, 606 S Olive Street, Suite 307, Los Angeles, Calif. 90014-9976 POLK COURT REPORTERS U /W i: A Well, it would certainly be nice if there 2; were that information, but about nine times out of ten 3 I to ninety-nine out of a hundred that information is not 4 : available, so, practically, it is so seldom available that i 5 it is rarely able to be considered because of its absence. 6 Q So, in short, you have no figures on the 7 level of exposure; is that correct? 8 A That's right. 9 Q And the only information you have regarding 10 the duration of exposure is what is contained in your 11 report? 12 A Well, that summarizes it. There was more 13 information in the store he gave me, but I have summarized 14 it. 15 Q What other information do you have 16 regarding the level of exposure other than what is 17 contained in your report? 18 A Well, we have no information about level of 19 exposure. I thought we had established that two or thre 20 questions ago. 21 Q I don't think you were listening to my 22 question. I was talking about duration. 23 A But you asked about level, and I am 24 pointing out to you that if you are asking about duration 25 now you have changed your horses, so which one are you j QUORUM Worldwide letocootoroxtng <n our offices Computer transcription Videotaping. Key Word and Phrase Indexing. SUBPOENA SERVICE IBM ASCII Dvkenes. Page Image or Armew*. BaronData> DISCOVERY ZX Oetaectes: 5% or 3v* i} f Data Dynamics Corporation ,80006 46 Call Tbll-Free Outside California 800 533-5640 Inside California 800 533-5641 FAX (213)625 1850 Local Telephone 1213)636-7615 606 a Olive Street, Suite 307, Los Angeles* Calif. 90014-9976 POUt COURT REPORTERS CU/L/ asking about? 2 ! Q Okay. Let's start over again and make sure 3 I we are talking about the same thing. 4 ! A Well, just be sure the language you use is 5 what you are intending. 6 Q Doctor, I am not here to argue with you. 7 I am here to get some information. We are trying to find 8 the truth. 9 A Well, we can look back in the record if you 10 don't think you were asking about level of exposure, but 11 you were, so if you now want to ask about something els , 12 please go ahead. 13 MR. UNGLESBY: I will be glad to stipulate 14 that Dr. Kilburn does not know any level or extent of 15 exposure. All of his information is historical, and if 16 what Mr. Smith has told him is incorrect, then that would 17 obviously affect that portion of his opinion, and I think 18 it was clear in the way I questioned him. If it wasn't, 19 it should have been, that his knowledge of what Smith's 20 exposure was has come solely and completely from Smith. 21 MR. CARLSON: Okay. 22 Q [By Mr. Carlson] Now, with respect to the 23 duration of exposure, do you have any other information 24 regarding the duration of exposure by the plaintiff other 25 than what is contained in your report? C- QUORUM Wykiwide Toleconte--ncing m our offices. Computer transcription. Videotaping. Key Worn and Phrase Indexing. SUBPOENA SERVICE IBM ASCII 0 Pga Image or Aimcua, P BaronDataDISCOVERY ZX Dokaitaa: sv. or 3v, Data Dynamics Corporation % Uri,s pout COURT REPORTERS C.rufu.l 50006, 47 Call Tbll-Free Outside California 800 533-5640 Inside California 800 533-5641 FAX (213)625 1850 Local Telephone (213)625 7615 A No. 2 I Q The information that you have regarding It 3 i the nature of the plaintiff's employment after 1974, where 4 I did that come from? 5 A From him. 6 Q And the information about he being a member 7 of the Dow Response Team to railroad spills and derailment 8 of chemical cars, where did that information come from? 9 .A From him. 10 Q Did he indicate to you thefrequency when 11 he would participate in that activity, if any? 12 A Well, as I recall, it was, you know, highly 13 variable, from once or twice a year to every month or so. 14 I don't recall anything beyond that. 15 Q Do you have anything in your file on this 16 plaintiff other than your report which consists of five 17 pages and then three pages oftables? 18 A Yes. 19 Q May I see it? 20 THE WITNESS: While you are doing that, can 21 I take a short break? 22 MR CARLSON: Sure. 23 [Recess taken.] 24 Q [By Mr. Carlson] When you examined the 25 plaintiff on June 20, 1989, there is an entry in your 606 & Olive Street, Suite 307, Los Angeles, Calif. 90014-9976 QUORUM Wtfdwide Teleconferencing tn our office*. Computer transcription Videotaping. Key Word and Phrase indexing. SUBPOENA SERVICE IBM ASCII Psfl* Imago or Amcu*. P BaronDataDISCOVERY ZX Ookanu: 5vt or 3V, Data Dynamics Corporation 0006. 48 Call Tbll-Free Outside California 800 533-5640 Inside California 800 533-5641 FAX (213)625 1850 Local Telephone (213)625 7615 ij report for a physical examination. "The plaintiff 2 i appeared in no acute distress." Is that correct? i 3 ii A Yes. 4; Q You examined his lungs at that time? 5 A Yes. 6 Q His breathing was normal? 7 A Yes. 8 Q Moves air well? 606 & Olive Street, Suite 307, Los Angeles, Calif. 90014-9976 POU COURT REPORTERS Ctrn(iJ 2><poution 9 A Yes. 10 Q Breath sounds normal? 11 A Yes. 12 Q Breath sounds of normal duration? 13 A Yes. I1 14 Q No adventitial sounds? 15 A That's right. 16 Q You also performed a neurological physical 17 examination? 18 A Yes. 19 Q His reflexes wereactive andsymmetrical? 20 A Yes. 21 Q The 4-plusupper and lower, what does that 22 indicate? 23 A Well, they are actually hyper, hyperactive. 24 It is a minimal stimulus is enough to elicit all of his 25 reflexes. V i? QUORUM Worldwide Teteconfewxrmg m <w offices Computer transcription. Videotaping. Key Word and Phrase Indexing. SUBPOENA SERVICE IBM ASCII OekMs, Page image or Amcue P BaronData,svDISCOVERY ZX Diskettes. or 3Vi Dynamics Corporation .80006 49 Call 'tell-Free Outside California 800 533 5640 Inside California 800 533-5641 FAX (2131625 1850 Local 'telephone (213)625 7615 t 1 ; Q His muscle strength was normal? 2 A Yes. 3 Q And symmetrical sensations grossly intact? 4 (i A That's right. 5 Q Chest x-rays were done? %/ 6A 7Q 8 evaluation? Yes. And they were suitable quality for your t i 9 A Yes. 10 Q He displayed normal lung fields? 11 A Yes. 12 Q And there were no pleuralabnormalities? 13 A That's right. 606 a Olive Street, Suite 307, Los Angeles Calif. 90014-9976 POUC COURT REPORTERS 14 Q Now, Doctor, with respect to your findings, 15 which of the pulmonary tests are in your opinion the most 16 important for assessing small airway obstruction? 17 A Well, the most standard one is the 18 FEF 2575. 19 Q Could you interpret your findings based 20 upon that? 21 A Well, the numbers arereduced, which is 22 evidence of obstruction, and of, in all probability, air 23 trapping, because that is the consequence of that type of 24 obstruction. 25 Q With respect to the forced expiratory flow. C QUORUM Worldwide Teleconferencing m our office*. Computer transcription videotaping. Key word anp Phrase indexing. SUBPOENA SERVICE * BaronDataIBM ASCII OiSkMHn. p9 Imagt Of Aimeui. DISCOVERY ZX DttkwtM. 5V4 or V/i Data Dynamics Corporation * 80006 * ij 50 Call Tbll-Free Outside California 800 533 5640 Inside California 800 533-5641 FAX (213) 625 1850 Local Telephone (213)625 7615 606 S. Olive Street, Suite 307, Los Angeles, Calif. 90014-9976 row COURT REPORTERS Cuf,.J 2>Vom0,, 1 ! 2575, he performed at 60 percent; is that -! 2 i A Of his predicted, yes. 3j Q And his predicted is based upon what? i 4 A His sex, race, height, and age, and in 5 a nonsmoker, absence of cigarette smoking. 6 Q So this is compared against another 7 population, if you will, of not any prior PFTs? 8 A Well, I had no access to prior PFTs, so it 9 is compared to a standard population. 10 Q And there are individual differences in the 11 force expiratory flow test? 12 A I'm sorry, I don't know what you mean. 13 Q Let me withdraw the question. 14 With respect to someone's lung capacity, 15 there are individual variations; is that correct? 16 A Yes. 17 Q And is there any factor of patient 18 compliance in the FEF 2575? 19 A Well, compliance is with making a 20 spirogram, and efforts to give it anything but a full 21 force expiration are pretty easily detected and usually 22 apparent to the technician who is doing the job. 23 Q But, in other words, if a patient wanted 24 to, a patient could not just blow out all of the air in 25 the lungs; right? QUORUM Wortdwpa Teleconferencing m our Computer transcription, videotaping. Key Word and Phrase indexing. SUBPOENA SERVICE ISM ASCII OofcMM. zxPag* image or Anwsja, DISCOVERY Ookaftaa, 5V. or ay, BaronData Corporation POUt COURT REPORTERS C.,nfuJ 2>., 8,0006 . 51 Call Tbll-Free Outside California 800 533-5640 Inside California 800 533-5641 FAX (213)625 1850 Local Telephone (213) 625 7615 A Well, that's possible, but what is done is 2 ! a series of tests are done, and they must duplicate within i 3! 5 percent, and it is very hard to vary it volitionally and 4 come that close, so even an expert would find it difficult 5 to give less than a full effort and get a duplication of 6 that effort in multiple tries. 7 Q Were -- The PFTs that were run, were they 8 run by a technician -9 A Yes. 10 Q -- in your office, not by you personally? 11 A That's right. 12 Q Would the patient'sarthritis affect th 13 FEF 2575? 14 A No. 15 Q What about pain from the arthritis in th 16 back area, would that have an effect on it or could it 17 have an effect on it? 18 A Well, if it is painful to take a full 19 breath, then the forced vital capacity might be reduced, 20 but everyone agrees in the fraternity of pulmonary 21 function the flow rates are not effort-dependent; they 22 are actually dependent on the caliber of the airways 23 rather than on effort, so they are pretty clearly 24 independent of whether or not a full breath is taken. 25 Q How would you characterize the extent of 606 S. Olive Street, Suite 307, Los Angeles, Calif. 90014-9976 QUORUM Wotldwide Taleconlsrancing m out ottices Computer transcription. Videotaping. Key Word and Phrase Indesmg. SUBPOENA SERVICE IBM ASCII OoketM. Page Image or Anucus. P BaronDataDISCOVERY ZX Diskettes: 5v, or 3Vi Data Dynamics Corporation POLK COURT REPORTERS C U fiJ %,Po,,,io., fU ,,., 8 O'O 0 6 52 C all Tbll-Free Outside California 800 533-5640 Inside California 800 533-5641 FAX (213)625 1850 Local Telephone (213} 625 7615 1 the small airway obstruction that you found in the 2 plaintiff? And by that I mean mild, moderate -- 3 A It's moderate. 4 Q Do you have any view as to when the onset 5 of the small airway obstruction occurred? 6 A No, there is no way that -- with the 7 information that I have at the moment. 8 Q Is there a latency period that you would 9 expect to occur if in fact the small airway obstruction 10 was caused by exposure to vinyl chloride monomer? 11 A Well, the latency is very short. It is 12 like other chemical exposures which I have mentioned such 13 that effects on occupational groups have been seen, you 14 know, when the studies were performed, which was while 15 people were in exposure and when they had relatively brief 16 exposure; by that I mean a few years, not twenty or thirty 17 years. 18 Q You were involved in the train derailment 19 in Livingston Parish? 20 A Well, I wasn't involved with the 21 derailment, no. 22 Q Okay. Let me withdraw the question. 23 You were involved as a plaintiff's expert 24 in the Livingston Parish train derailment where there was 25 a release of vinyl chloride? 606 & Olive Street, Suite 307, Los Angeles, Calif. 90014-9976 QUORUM Woridwxto T*teconf*w>ang n our othcts. Computer transenptcn Videotaping. Key word and Phrase indexing. SUBPOENA SERVICE IBM ascii OBkams. Pag* imaga at Amicuj. DISCOVER? ZX Dofcanaa: 5V. at 3Vt BaronData, Data Dynamics Corporation 7 U ,,,, POUt COURT REPORTERS ,/,/,,/ 0006, I 53 Call Tbll-Free Outside California 800 533-5640 Inside California 800 533-5641 FAX <213)625 1850 Local Telephone <213)625 7615 1 A Yes. i 2j Q Was it the same plaintiff's attorney who 1 3i you are working with on this case? 4 A Yes, it was. 5 Q Do you remember when that spill occurred? 6 A I can't be sure offhand. I'd guess 1981 or 7 something of that sort. 8 Q Are you aware that the plaintiff in this 9 case was also a plaintiff in that class action? 10 A No, I wasn't. 11 Q Are you aware that he claimed acute 12 exposure to vinyl chloride as a result of that derailment 13 because of the proximity of his residence to the 14 derailment? 15 A No, I didn't know that. 16 Q If that were the fact, wouldn't it be more 17 likely that the onset of small airway obstruction would be 18 as a result of that derailment as opposed to his exposure 19 from 1970 to '74? 20 A Well, without more information, I'd hav to 21 say no, I don't think so. 22 Q What more information would you need? 23 A Well, if any medical information suggested 24 he had acute symptoms after the derailment. 25 Q If there were such evidence, then your 606 & Olive Street, Suite 307, Loa Angeles, Calif. 90014-9976 QUORUM Worldwide Teleconferencing m our often. Computer traracnpton VKtaxipmg. Key Word and Phrase indexing. SUBPOENA SERVICE BaronDataIBM ASCII Otsxettn Page image or Amcue. DISCOVERY ZX Diskettes; 5'/* or 314 Data Dynamics Corporation  80t 0.'06 54 Call Tbll-Free Outside California 800 533-5640 Inside California 800 533 5641 FAX (213)625 1850 Local Telephone (213)625 7615 606 S. Olive Street, Suite 307, Los Angeles;, Calif. 90014-9976 POLK COURT REPORTERS Cuf,J t 1 i opinion may be different? 2! A Well, I doubt it. i 3! The people I have examined from that 4 i derailment have not had significant airways disease, so I 5 so far I don't have any experience with airways disease 6 from that episode, the derailment episode. 7 Q Do you have any ongoing doctor-patient 8 relationship with the plaintiff? 9 A No, I have not seen him again. 10 Q What medical records of the plaintiff have 11 you reviewed prior to your examination of the plaintiff on 12 June 20th of '89? 13 A I didn't review anything prior to my 14 examination. 15 Q Would you expect that if the plaintiff were 16 complaining of those complaints which are contained in the j 17 Review of Systems in your report on Page 2 -- Well, let me 18 back up and ask you: Under the Review of Systems, it says 19 general headaches, dizziness, fatigue, chills, fever, and 20 thirst. 21 Does that mean that at the time that he j ` .i 22 presented on June 20, '89, that is the way he felt on that 23 day? 24 A No. 25 Q Well, what does that mean, then? QUORUM worldwide Teleconferencing m our offices. Computer transcription. Videotaping. Key Word and Phrase indexing. SUBPOENA SERVICE IBM ASCII OsJuttn P BaronData,Pag* long* or Arman. CHSCOVERV ZX OstWTlM: 5% or 31* Data Dynamics Corporation 80606 55 Call Tbll-Pree Outside California 800 533-5640 Inside California 800 533-5641 FAX (213)625 1850 Local Ifelephone (213)625 7615 ffofaries 606 & Olive Street, Suite 307, Los Angeles, Calif. 90014-9976 POU COURT REPORTERS C.,ufiJ 72 ) ^ , , 1 A Well, the way the question is asked, it's 2 "While at work have you experienced more than once a month 3 any of the following?" And those symptoms were based on 4 his answer to that question. 5 Q Now, does that -- Would that be the same 6 time periodand the same type of a question for all of the 7 other systems that are listed under Review of Systems in 8 your reporton Page 2? 9 A Yes. 10 Q Now, under the "Respiratory History," what 11 does that mean? Does that mean how he presented on June 12 20th? 13 A No. Well, yes and no. That is his 14 history, so up until June 20th that is what he reported. 15 It's not meant to be today or the past week; it's meant to 16 be his history, history in total. 17 Q With the information that he gave you 18 regarding his respiratory history, are you aware of 19 whether that same type of information has been reported 20 to any other treating doctor of Mr. Smith's? 21 A No, I'm not. 22 Q Would you expect those complaints to be 23 significant enough that if he had those complaints that 24 they would have been reported to prior doctors? 25 A Well, you are asking me to do all kinds of QUORUM Worldwide Teleconferencing m our offices. Computer tranecnouort Videotaping, Key Word and Phrase indexing. Subpoena service * BaronDataIBM ascii Dtswn**. Pig* Mug* or Amicus. DISCOVERY ZX Oiswnw. Sv. or 3'/, Data Dynamics Corporation 80006 56 speculation. I really don't know. Q But this type of information was important to you in assessing his lung function; is that correct? A Well, it helps to know what the symptoms are. You sort of -- When you assess function, you measure function, and we measured it, and we have talked about it already, so -- f Q Right. A -- it's not -- If you mean is this important in assessing his overall respiratory condition, c the answer is yes. It isn't helpful in assessing his lung function, which we do with objective testing. Q And you would expect that if a patient is c suffering from the type of matters that are listed under the Respiratory History that this would be significant * 16 enough that he would give this information to an examining c and treating doctor, would you not? A Well, I guess my expectation would be that it would be elicited if asked for. You have asked about c giving it to -- If questions aren't asked, you often don't get information. Q Okay. Now, on Page 4 of your report under c wo "Diagnosis/Continued," if other symptoms include loss of 24 balance, fatigue, insomnia, irritability, depression, 25 recent memory loss, lack of concentration, headaches, c QUORUM Worldwide Teleconferencing in our offices. Computer transcription. Videotaping. Key Word and Phrase indeimg. SUBPOENA SERVICE * BaronData,IBM ASCII Osfcanaa. Pag* Imaga or Aitmcu*. DISCOVERY zx DtsAma*. Sv. or 3Vi Data Dynamics Corporation 80006 57 Call Tbll-Free Outside California 800 533-5640 Inside California 800 533-5641 FAX (213)625-1850 Local Telephone (213)626-7615 606 S. Olive Street, Suite 307, Los Angeles* Calif. 90014-9976 POIK COURT REPORTERS C.rtift..l 2>. ,n 1 ! dizziness, and unusual acceleration -- 2i * A Exhilaration, e-x-h-i-1 instead of a-c-c. sj Q That was one of my questions. So that is 4 i a typo? 5 A Yes. 6 Q And these symptoms that you have listed 7 here were of assistance to you in your overall diagnosis? 8 A Well, they -- obviously, they correlate, 9 usually, with testable deficiency. 10 It is unusual that people don't recognize, 11 for example, that they have memory loss when they do. Some 12 people who have extraordinarily bad memory loss aren't 13 aware of it, but usually the brain is pretty facile at 14 recognizing its own problems. 15 Q These were symptoms that you found 16 important in your overall evaluation of the plaintiff; 17 is that correct? 18 A Yes. 19 Q Would you expect that if a patient 20 presented to another physician with these same types of 21 problems for an evaluation that the patient would tell 22 those doctors about these symptoms? 23 A Well, again, I don't know. How could I 24 place myself in his position? 25 Q But, normally, if someone comes in for QUORUM Worldwide ifeieconfVftftCinQ *n our offices. Compute* transcription VidetfApmg. Key Wotd and Phrase Indexing. SUBPOENA SERVICE * BaronDataIBM ASCII Diskette*. Page Image or Amicus. DISCOVERY ZX Diskette*. 5% or Data Dynamics Corporation 80006 58 Call Tbll-Free Outside California 800 533-5640 Inside California 800 533-5641 FAX (213)625 1850 Local Telephone (213)625 7615 7U,,-,, 606 S. Olive Street, Suite 307, Los Angeles, Calif. 90014-9976 POU COURT REPORTERS 1 an evaluation, such as a patient, and has problems with 2 Z 'I fatigue, insomnia, irritability, depression, and memory i 3 | loss, lack of concentration, you would expect the patient 4 ! to tell the doctor either by means of listing them in 5 the history section of the initial form or by telling 6 the doctor orally that these are the symptoms, these are 7 the problems that I have? 8 A No, I don't think you can say that. You 9 know, we -- I specifically ask about those things, and I 10 determine what I have said on the basis of the question. 11 I can't tell you what might be. 12 Q Well, then I wasn't clear. So, in other 13 words, you asked him if he had these conditions; he didn't 14 volunteer to you that, "Doctor, this is the way I feel: 15 I feel tired, I don't sleep well," et cetera. Is that 16 right? 17 A Well, the paragraph we are talking about 18 came from questioning him. I don't have an independent 19 recollection of how many of these things he complained of 20 when I first spoke with him. 21 Q These tests which we refer to as the 22 neurobehavioral tests, who administered them? 23 A I did. 24 Q Was there any neuropsychologist involved in 25 administering them? QUORUM Worldwide Teteconterenong m our offices. Computer transcription Videotaping. Key Word and Phrase indexing. SUBPOENA SERVICE * BaronDstaISM ASCII CSIMMS. Pag* Imag* or Anwua. DISCOVERY ZX Oaken**. S'/. Vh Data Dynamics Corporation 80006 59 Call Tbll-Free Outside California 800 533-5640 Inside California 800 533-5641 FAX (213)625-1850 Local Telephone (213(625 7615 606 & Olive Street, Suite 307, Los Angeles, Calif. 90014-9976 POLK COURT REPORTERS C.,u(;.J 1 A No. 2 Q Was there any neuropsychologist involved in 3 the interpretation of the test results? 4 A No. 5 Q Doctor, under Table 1 it says "Choice 6 Reaction Time/Eye-hand coordination motor speed," and the 7 source is Kilburn, with references 11 and 16. 8 What do the references refer to? 9 A Well, thisis a reference list that goes 10 along with this table. It is actually the reference list 11 out of the paper which I referred to on the firemen. The 12 reference, I think, is 158 in my CV. 13 Q So both 11 and 16 refer to 158 on your CV? 14 A Yes,'as do all the numbers under the 15 Reference column. 16 Q You would admit that a sample size of 17 fourteen controls is a small sample? 18 A I don't really know how to answer that. 19 Small compared to what? 20 It was a sufficient sample size for what we 21 were doing with the firemen, and it gave us very reliable 22 comparative data, which says that it was an adequate 23 sample size. 24 Q Well, Doctor, you are not an 25 epidemiologist, are you? QUORUM Worldwide Teleconferencing m our otfices. Computer transcription Videotaping. Key Word and Phrase Indexing SUBPOENA SERVICE IBM ASCII Diskette* Page Image or Amicus. P BaronDataDISCOVERY ZX Diskettes. $va or 3>* Data Dynamics Corporation 80Q06 60 Call Tbll-Free Outside California 800 533-5640 Inside California 800 533-5641 * FAX (213)625-1850 Local Telephone {213)625 7615 ?U,,,, 606 & Olive Street, Suite 307, Los Angeles, Calif. 90014-9976 POLK COURT REPORTERS C.rnf>J 1 A Yes, T have practiced epidemiology for more 2 than twenty years. 3 Q Do you consider yourself an expert in 4 epidemiology? 5 A Yes. 6 Q Are you certified in epidemiology? 7 A There is no certification in epidemiology. 8 Q Are you a member of the American College of 9 Epidemiology? 10 A I am not aware of there being a college. Q Are you.aware of any professional 12 organization which recognizes epidemiologists? 13 A Well, there are several. I am a member of 14 the International Epidemiology Association. 15 There is also an American and British 16 Epidemiology Association which I haven't bothered to join. 17 As Mr. Unglesby brought out, I am a member 18 of this international body on neurobehavioral methods in 19 epidemiology, which has been in existence for about twelve 20 years. 21 Q The purpose of using the fourteen controls 22 was to have some baseline data to compare the findings of 23 the plaintiff to? 24 A That's correct, yes. 25 Q And the idea of having a control would be QUORUM Worldwide Teleconferencing in our offices Computer transcription Videotaping. Key Wort and Phrase Indexing. SUBPOENA SERVICE * BaronData,IBM ASCII Otfkefles. Pag* Image or Amicus. DISCOVERY ZX Diskettes 5V. ,, 31/, Data Dynamics Corporation 80006 i 61 to have someone that reflects a sampling of the general xr-~ ih c'Xm i | population? ! A Not necessarily, no. --o i I 2 Q Well, what were you trying to do, then, by s-sS ^ using the control for these neurobehavioral tests if not CM to compare them to someone who was representative of the Lix FAX ~-j < general population? 3to 8 OV ** CO S9 0 8- 210 '5 111 QV 12 L. Il3 VI co op 3 ^ 35 sOT *^13015 H i 16 00 o 1^ 1s 17 <c Q"=3 1-LO8 3 2 i19 20 in3 %21 .:- l^22 WO 23 p* o c/1 24 8 to 25 A Well, the general population includes people in institutions, people in hospitals, children in school, none of which are pertinent for comparing workers to, generally, because of many reasons. Leads to confounding, one of which is the healthy worker effect. You try to compare workers to workers. Now, ideally, you compare, I guess, chemical workers to chemical workers, but for neurobehavioral *-- testing, that is an oxymoron, because you then are likely to dig yourself a comparative ridiculous situation where you don't know which group is, quote, "the referent," so you try to get a referent population that has not had the exposure but has as many characteristics as possible in common with the exposed population. Q Well, you would agree that, generally, firemen are in better physical shape than the average working population? A I don't know that that's true. That's true QUORUM Worldwide Teleconferencing m our offices Computer transcription. Videotaping. Key Word and Phrase indexing. SUBPOENA SERVICE IBM ASCII Diskette* Page image or Amicu*. * BaronDataDISCOVERY ZX Diskettes, 5% or 3V* Data Dynamics Corporation tU ,:, POU COURT REPORTERS ,/,/,,/ 80006 62 Call Tbll-Free Outside California 800 533-5640 Inside California 800 533-5641 FAX (213)625 1850 Local 'telephone (213)625 7615 when they take their exam to become firemen, but from examining firemen I know it is not true when you look at 3 I people spread across up to twenty or twenty-five years of i 4 time as a fireman. 5 Q But the ages of the fourteen firemen 6 controls were in the area of 30 to 37? 7 A Well, that's where the mean was in the 8 confidence intervals. There were two or three people who 9 were in the early twenties, and there were, I think, two 10 or three people who were over 40. The oldest one, I 11 think, was 51 or 52. 12 Q But the mean of the ages was 34.9? 13 A Yes. 14 Q And then you compared the plaintiff, who is 15 41 years old with arthritis, to a mean age of 34.9? 16 A Yes. 17 Q Now, of these things that you ran, as I 18 understand it, these pluses mean that the plaintiff was 19 outside of the range of fourteen firemen; is that right? 20 A Well, if you use range to mean confidence 21 intervals, yes. 22 Q Well,outside theconfidenceintervals; 23 what does that mean to you? 24 A Well, the chances are less than one in 25 twenty that he would be there and be normal. 606 S. Olive Street, Suite 307, Los Angeles, Calif. 90014-9976 OUORUM WoridwtOe 1M*conferftGtAg *n our offices Computer transcnption Videotaping Key Worp and Phrase Indexing. SUBPOENA SERVICE IBM ASCII Oaken**, Page Image w Ameu* DISCOVERT ZX Oaken**; 5V. or 3v, BaronData Data Dynamics Corporation 80006 63 Call Tbll-Free Outside California 800 533-5640 Inside California 800 533-5641 FAX (213)625-1850 Local 'telephone (2131625-7615 1 i Q But you would agree that he was normal in l 2 most of the categories that you measured than those where 3 : he was not normal? 4 i A I don't know what you mean by that. i 5 Q Well, in other words, just simply look at 6 the list. You have indicated that the pluses mean that 7 he was outside the normal range, and all I am trying to 2>v h,.,,,, 8 understand here is that it appears to me that he was much 9 more normal than he was abnormal under these various items 10 that you have on Table 2. 11 A Well, are you a neurologist who can equate 12 one of these tests to another, or say they are all equal? 606 a Olive Street, Suite 307, Los Angeles, Calif. 90014-9976 POLK COURT REPORTERS 13 Because they are not, and it is part of what the 14 interpretation is based on. 15 Q Okay. 16 A They cluster to describefunctions, and 17 there are some things that are in here more or less that 18 faithful performance is occurring, like digits forward and 19 backward. 20 Q Well, let's just take -- 21 A And you are counting as normal some of the 22 predecessor information. 23 For instance, I could have marked all of 24 the choice reaction times as being abnormal, which they 25 are. I simply marked it once. C QUORUM Wortdwde Teleconferencing m our offices Computer transcription. Videotaping Key Word and Phrase Indexing. subpoena SERVICE * BaronDataIBM ASCII OsMM Pag* Inwg* or Amicus. DISCOVERY zx DtWwnes; 5'/. or JVY Data Dynamics Corporation 800.06 64 Call Tbll-Free Outside California 800 533-5640 Inside California 800 533-5641 FAX (213)625-1850 Local Telephone (213) 625 7615 7U,,., 606 & Olive Street, Suite 307, Los Angeles, Calif. 90014-9976 POW COURT REPORTERS C.,uf:.,l 1 If you are counting lines, then, you know, i2 that would have to be counted the other way. 3! I Q Let's approach it simply Story 1, verbal ! 4 memory is 10-plus; that the range of the plaintiff falls 5 outside of the confidence intervals. 6 Am I interpreting that correctly? 7 A Yes. 8 Q The next line, Story 2, verbal memory, 8; 9 there is no plus. So that means it falls within the 10 confidence interval? 11 A Well, he is right on the confidence 12 intervals. 13 Q But that would be -- 14 A I haven't leaned over to call anything that 15 was borderline positive is all that means. 16 Q Sure. That's the only thing I'm trying to 17 do here. Doctor, is to understand it. 18 So under that one, he fell within the 19 normal range? 20 A Well, it is on the border, yes. 21 Q Okay. Next one. Digits Forward, the 22 plaintiff had a 7. He is within the normal range on that; 23 correct? 24 A Yes. 25 You skipped over the next one, which was QUORUM WorkJwd* Teleconferencing m our office*. Computer transcription. Videotaping. Key Word and Phrase indexing. SUBPOENA SERVICE * BaronOataIBM ASCII Diskettes, Page image or Amicus. DISCOVERY ZX Diskettes. Sv* or 3v Data Dynamics Corporation 80G06 65 Call Tbll-Free Outside California 800 533-5640 Inside California 800 533-5641 FAX (213)625-1850 Local Telephone (213)625 7615 606 & Olive Street, Suite 307, Los Angeles, Calif. 90014-9976 POIK COURT RtPORTfRS C.,uft,J 1 ! Visual Memory, but -- 2 i: Q Well, let's -- Okay. 3! to my question. Let's get an answer 4 In Digits Forward he is in the normal 5 range? 6 A Yes. 7 Q Digits Backward he is in the normal range? 8 A Yes. 9 Q Now, what is thesignificance of when it 10 says Errors? What does that mean? 11 A Well, it is whether or not in the 12 performance of his tasks he made errors or not. That 13 is what it means. 14 Q Now, the next one is Finger Perception; is 15 that right? 16 A No. Itis perceiving numbers on thetips 17 of the fingers. 18 Q And under Error Writing Left he was within 19 the normal range? 20 A Yes. 21 Q Embedded Figures, he was within the normal 22 range -- 23 A Yes. 24 Q -- correct? 25 A Yes. QUORUM Worldwide Teleconferencing m our offices. Computer transcription. Videotaping. Key Word and Phrase indexing. SUBPOENA SERVICE IBM ASCII DtskwtM, Pag# imaga or Airwua. BaronData* DISCQVERV ZX Dokafla*. sv, or 3Vi _________________ ii a Date Dynamics Corporation tU n* POU COURT REPORTERS CU/,.,/ 80006 66 Call Tbll-Free Outside California 800 533-5640 Inside California 800 533-5641 FAX (213)625-1850 Local Telephone (213)625 7615 1 Q Under Reaction Times, Simple 1, he was in 2 the normal range? 3 A Well, we don't have ranges from the 4 firemen, so we can't really address those three numbers. 5 Q Now, under Balance it says Eyes Open 1. He 6 was within the normal range? 7 A Yes. 8 Q And Eyes Open 2, he was within the normal 9 range? 10 A No. That is outside the confidence 11 interval. 12 Q Eyes Closed, he was within the nprmal 13 range -- 14 A Yes. 15 Q -- for 1 and for 2? 16 A Yes. 17 Q And this is in spite of his arthritic 18 condition; is that correct? 19 A Yes. 20 Q The Digit Symbol, 46, that is normal? 21 A Well, again, I don't have comparative 22 information for the firemen. 23 Q The Information, 25, that is normal? 24 A Yes. 25 Q Similarities is normal? 606 & Olive Street. Suite 307, Los Angeles, Calif. 90014-9976 QUORUM worldwide Weconlemncing in our offices Computer irensenpwn. VsJeaapmg. Key Wore and Ptwas* Indexing. subpoena service IBM ASCII Dqfcattw, Page Image or Amicua. DISCOVERY ZX Oskette*. 5v. or 3Vi BaronDafa Data Dynamics Corporation 80006 67 12 1 tte> im'Xn> -o -| COO. $mo* {| ?0 <f--N* C3 jx ITS 3i co cio 00 ft .Lc2 -w 0)12 0 1x3 | ii14 O cfi3UO15 an o & 9 Ou J<tp2f O17 1318 s h V Jii9 s SCO.* om3 20 ^ fi 033 --^ 21 *f Sc =a 22 OT O S 23 o o5 24 c 25 A Yes. Q Picture Completion isnormal? A Yes. Q And I believe, as you have indicated in the third page of your chart, for Tension, Anger, Depression, Vigor, Fatigue, Confusion, all of his scores were in the normal range? A Yes. Q These neurobehavioral tests, the way you have put them together, the first time that they will be published will be through this publication in the British journal; did I understand you correctly? A No. Q No. What is it that is being published in the British journal? A It is a description of a knee apparatus that we devised for measuring balance or sway speed. Q So these tests that you have run comparing individuals to the firemen, has that been published any place? A Well, as I have said three or four times, the firemen paper was published in 1989. I gave you the reference. It is in my CV. Q Let me make my question clearer. I understand that you have published the firemen studies QUORUM Wbrldwido Teteeonferenemg m our offices. Computer transcnpton Videotaping Key Word and Ptiras* Indexing. SUBPOENA SERVICE IBM ASCII Dokann Pag* Imag* or Arman* DISCOVERY ZX Dakin**, Sv. or V/, BaronData a Dynamics Corpora** 2>.pMiuOH POLK COURT REPORTERS C ^ J 80006 ,* 68 Call Tbll-Free Outside California 800 533-5640 Inside California 800 533-5641 FAX (213)625 1850 Local Telephone (213)625 7615 i! as No. 158 on your CV. 2 i My question is: Using that, the firemen, 3! as a reference group and then comparing other individual i 4 , patients or plaintiffs in lawsuits, have you published 5 that anyplace? 6 A Here, what do you mean by "published"? You 7 have got me totally -8 Q Published in a medical or scientific 9 journal. 10 A That's -- I'd have to say no because I 11 don't understand the question very well. 12 Q Well, let me see if we can't communicate on 13 this. 14 I am just trying to determine. Doctor, if 15 you are using the firemen as a control group and then you 16 take the individual plaintiff in a lawsuit and you compar 17 them to the firemen and come up with these scores, has 18 that methodology protocol, if you will, been published any 19 place, medical journals or scientific journals? 20 A Well, there is a paper on, again, 21 a Louisiana man who was exposed to hydrogen sulphides, 22 which will be published in the fall in the American 23 Journal of Medicine; also listed in my CV is such 24 a description. 25 Q What number is that in your CV? 606 a Olive Street, Suite 307, Los Angeles, Calif. 90014-9976 QUORUM Woftjwxto Teleconferencing tn our offices. Computer transcription. Videotaping Key Word and Phrase Indexing. SUBPOENA SERVICE IBM ASCII OskDftM. Pag* Image or Armas. f* DISCOVERY ZX Oskeaes. S'/, or 3Vt BaronData. Data Dynamics Corporation POUC COURT REPORTERS C U /,,,/ 80006 69 Call Tbll-Free Outside California 800 533-5640 Inside California 800 533-5641 FAX (213)625 1850 Local Telephone (213)626 7615 1 A Hand it to me and -i 2 | Q Okay. i 3 j A It is No. 4 listed under "In Press." 4 i Q Okay. Let me make sure that we understand. 5 I asked you whether you had published. You 6 have one in press. 7 Do you have any published? 8 A We have gone through that, really, Jeff. 9 The firemen paper is published. I have 10 a preceding paper about histology technicians. I have 11 said what I have said, and In Press represents that it has 12 been accepted. It is somewhere between the typesetter and 13 the printer and the publisher at the present time. 14 Is it available? Well, not from the 15 Journal yet, because they only have it available once 16 they have formally published it, but it has gone through 17 all the steps taking it to that point. 18 Q Have you published any papers dealing with 19 an evaluation of a plaintiff exposed to vinyl chloride 20 monomer using the firemen as control groups? 21 A No. 22 Q Have you published specifically on any 23 studies that you have done with vinyl chloride monomers? 24 A No. 25 Q You were asked if you have qualified as an 606 S. Olive Street, Suite 307, Los Angeles, Calif. 90014-9976 QUORUM WoridwKJe TWtcontefenctnQ in our office*. Computer tranecnpdon. Videotaping. Key Word and PtiraM indexing SUBPOENA SERVICE IBM ASCII OiSkMM. Pag* Imag* or Amoa * DISCOVERY ZX 0ak*M*: 5% or 3V, BaronData Data Dynamics Corporation P O U COURT REPORTERS C .r n fu J 2 ) j,y 80,006 70 Call Tbll-Free Outside California 800 533-5640 Inside California 800 533-5641 * FAX (213)625-1850 Local Telephone (213)625 7615 1 expert in Louisiana courts. Which cases? 2 A Well, the first one was one concerning 3 Terry Wisner and the Illinois Central Railway -- Illinois 4 Gulf Railway, I guess it is. 5 Q Any others? 6 A Well, a case that concerns Livingston 7 Parish and multiple defendants -- not Avingdale -- What's 8 the name? 9 MR. UNGLESBY: The name of that case is 10 Combustion. That's what that will mean to the people when 11 you send it back home.. 12 Q [By Mr. Carlson] That's with the same 13 plaintiff's attorney as in this case? 14 A Yes. 15 Q And the Wisner case, is that with the same 16 plaintiff's attorney? 17 A Yes. 18 Q Any other cases where youhavetestified 19 and qualified as an expert in Louisiana? 20 A Yes. A case that's right now on the court 21 calendar in New Orleans concerning hydrogen sulphide 22 exposure. 23 Q Do youremember thename of the lead 24 plaintiff in this case or of the plaintiff? 25 A Well, I remember it. I don't know that I 606 a Olive Street, Suite 307, Los Angeles, Calif. 90014-9976 QUORUM vUoridwtM TataeorAtrancing m our ottieas. Computer transcription. Videotaping. Key Word and Phrase Indesing. SUBPOENA SERVICE IBM ASCII tetatM, Page Image or Ameu*. P DISCOVERY ZX Diskettes; 5V4 or 3Vfc BaronData si Data Dynamics Corporation fU,,- 80.006 71 Call Tbll-Free Outside California 800 533-5640 Inside California TOO 533-5641 FAX (213)625-1850 Local Telephone (213)625 7615 606 & Olive Street, Suite 307, Los Angeles, Calif. 90014-9976 POLK COURT REPORTERS C.ruf,.J i; should reveal it at this point. I will if -2 : HR. UNGLESBY: You can go ahead. 3 | A [Continuing] Steve Borque. 4 Q [By Mr. Carlson] I am sorry? York? 5 A Borque. 6 Q Borg? 7 A B-o-r-q-u-e. 8 Q Is that with the same plaintiff's attorney 9 as in this case? 10 A No. 11 Q When you said that you would not expect 12 this plaintiff to even be able to walk up a flight of 13 stairs, words to that effect, when did that begin? 14 A I don't know. 15 Q The studies which you mentioned by Monson 16 & Peters regarding cancer risk, you would agree that the 17 workers that those studies covered were vat cleaners with 18 PVC? 19 A That group was included, but it included, 20 I think, a vast number of production workers, handlers, 21 transporters, as well. 22 Q But wasn't the cancer found in the vat 23 workers and not any other handlers of PVC? 24 A I don't think it was broken down. I 25 haven't looked at the tables for some time. I don't think QUORUM worldwide Teleconferencing Compute# transcription. Videotaping. Key word and Phrase indexing. subpoena SERVICE our often. IBM ASCII Ottkann. Pag* Ifrag* or Anwu*. DISCOVERY ZX Dokwiw: S'', or 3'A BaronData, Data Dynamics Corporation COURTr o w REPORTERS C . , u f : J 2 ) .p<,M a n 80006 72 Call Tbll-Free Outside California 800 533-5640 Inside California 800 533-5641 FAX (213)625 1850 Local Telephone (213)625 7615 1 it was subdivided by subdivisions of category of work. 2 | Q Well, you are familiar with the 3 ! epidemiology studies which have shown cancer, but the 4 cancer has been limited to those vat workers with the PVC 5 where there was essentially hand-scraping of the vats? 6 A Well, I think that applies to the 7 angiosarcomas, but this study was a much broader study, 8 as was the German one that I referred to. 9 Q Now, with respect to the element of the 10 risk of cancer, there was no mention of that in your 11 report, was there? 12 A No. 13 Q And you didn't discuss that with the 14 plaintiff at the time, did you? 15 A There would have been no reason to, so I 16 probably did not. 17 MR. CARLSON: Makes it seem like you ar 18 not interested in what I have to say. 19 MR. UNGLESBY: Oh, no, no. X can't do 20 anything about what you have to say, Jeff, so I just enjoy 21 listening. 22 Q [By Mr. Carlson] Have you read any of the 23 depositions in this case? 24 A I have looked at some of the workers' 25 depositions, co-workers' depositions; that's all I have 606 & Olive Street, Suite 307, Los Angeles, Calif. 90014-9976 QUORUM Worldwide Teleconferencing in our offices. Computer transcription Videotaping Key Word and Ptvase indexing. SUBPOENA SERVICE IBM ASCII MMtt Page image or Ameu*. DISCOVERY ZX DsAettw. 5% or 3V, BaronData, Dynamics Corporation 2>.Pom.,, ROW COURT REPORTERS C U /,, / 80006 73 Call 'Ibll-Free Outside California 800 533-5640 Inside California 800 533-5641 * FAX (213)625 1850 Local Telephone <213)625 7615 1 looked at to this point. i 2 i Q Co-workers in this particular case? 3 ! A Yes. 4 Q Do youremember their names? 5 A No. 6 Q You have notreviewed any of the doctors' 7 depositions? 8 A No. 9 Q Have you reviewed any of the medical 10 reports from the occupational health group at Oschner 11 headed by Dr. Swift? 12 A No. 13 Q Do you know Dr. Swift? 14 A I don't think so. 15 Q He is head of the occupational group in 16 that area. 17 A Well, if you say so. I don't know, so... 18 Q I'm just trying to see whether that 19 refreshes your recollection of whether you know him. 20 A I knew Dr. Alexander, who was his 21 predecessor. I know one of the people, a woman in 22 the clinic whose name escapes me. Swift, if I met, I 23 don't recollect. 24 Q Would you feel that would be important to 25 your overall evaluation to determine what was reported by 606 & Olive Street, Suite 307, Los Angeles, Calif. 90014-9976 QUORUM Worldwide Teleconferencing m our offices. Computer transcription Videotaping. Key Word and Phrase indexing SUBPOENA SERVICE IBM ASCII Diskettes, tag# Image or Amicus. * DISCOVERY ZX Dakenes; 5% or BaronData. Date Dynamics Corporation > S0006 74 Call Tbll-Free Outside California 800 533-5640 Inside California 800 533-5641 FAX (213) 625 1850 Local ^le p h o n i' (313) 623 7615 POLK COURT REPORTERS U /,.,/ a&epostlioti fofuries 1 ! those physicians who tested the plaintiff? 2 : A You mean would it change my opinion? 3 ; Q No. Just whether it would be information 4 : that you would like to have available to you. 5 A May or may not be of interest. I don't 6 know. 7 Q Well, generally, you would like to have 8 as much information on a patient as you can in order to 9 properly evaluate the condition of the patient? 10 A Well, most evaluations are made on fairly 11 limited information, which is, you know, what one can 12 assemble at a point in time. 13 There is always more information possible, 14 but how much of that one contributes to a decision or 15 recommendation is hard to tell. 16 Q But as a general rule, you would want to 17 know as much about a particular patient before you arrived 18 at a diagnosis, isn't that correct, the patient's medical 19 background and concurrent evaluations by other physicians? 20 A Well, it depends on what the questions 21 being asked are. 22 Q With respect to the causation of the 23 plaintiff's claims. 24 A Well, as I say, it may or it may not be 25 helpful or contributory. 606 a Olive Street, Suite 307, Los Angeles, Calif. 90014-9976 QUORUM Worldwide Ifetoeoftferencmg m our offices Computer tranacnption Videotaping. Key Word and Phrase Indexing SUBPOENA SERVICE IBM ASCII OsfcMMs. Pmgt Image or Ameui. P BaronDatazx 5%DISCOVERY DnkMtos. or 3'/ Corporation * 80006r 75 Call Tall-Free Outside California 800 533-5640 Inside California 800 533-5641 FAX (213)625 1850 Local Telephone (213)625-7615 2 )tfjo M 'tio n /o tu rie i 1 Q Would it be helpful, Doctor, in determining the neurobehavioral facts that you have listed on Table 2 to know the previous history that the patient had given regarding these neurobehavioral aspects? 5 A I don't know what you mean by that. 6 Q Well, would it be helpful for you to know 7 about the neurological testing which occurred prior to 8 the time that you examined the patient on June 20, 1989? 9 A I think that would beinteresting, yes. 10 Q To your knowledge, has any otherdoctor 11 who has seen the plaintiff picked up any of these 12 neurobehavioral problems that you have seen? 13 A I don't know. 14 Q Did you do any nerve conduction testing? 15 A No. 16 Q Did you run an EMG? 17 , A No. 18 Q Would a patient's history of asthma be 19 something that you would want to know about in assessing 20 the causation of small airways obstruction? 21 A Yes. 22 Q Is asthma something that is thought to be 23 hereditary? 24 A Well, not in a direct sense, no. 25 Q Well, there is some literature out ther 606 & Olive Street, Suite 307, Los Angeles, Calif. 90014-9976 POLK COURT REPORTERS QUORUM Worldwide Teleconferencing >n our offices Computer transcription Videotaping. Key Word and Phrase indexing. SUBPOENA SERVICE ISM ASCII OskMtn. Pag* imag* or Amcu*. P BaronDataDISCOVERY ZX Oaxatta*. 5V, & 314 Data Dynamics Corporation 8000$ 76 1I 's> t7'A>) So gC s*7 J-CS>L rc^yOj n that suggests there may be a hereditary component to asthma. A Well, I think you are confusing hereditary and familial. There is some evidence that there is a familial increased likelihood of having asthma, but it is not a hereditary disease like muscular dystrophy K >s 3in 8 enwo qy 3 > *a10 <$ c J*?11 ^ 12 n <u ! 13 to Sop o3 l4 ** iS x30i ^nn1A5J u !a Sl6 m <-J3*a aS JoUr s 17 4Mc> ^ 18 a s< u S $ 3 19 So n 20 $8 M5 J21 _r 1 = 22 E CO OT o I 23 5 cri 24 or cystic fibrosis or -- Q So just to be more precise, what we are talking about is a family predisposition, if you will? A Well, it may be that, yes. Q Would that type of information be something that you would like to know about in assessing the causation of the plaintiff's small airway obstruction? A Well, it would be of interest, yes. Q Doctor, do you keep any lists of your testimony history? A No. Q Do you testify extensively? A I testify when I can't get out of it. Q Okay. Can you give us an indication of how many times you have testified in trial and how many times you have testified in depositions? A More in the neighborhood of fifty times in trial and a hundred in deposition. 25 Q Over what time frame? QUORUM WorktwKto Teleconferencing m our office*. Computer transcnpoort Videotaping. Key word end Phrase indexing. subpoena service IBM ASCII Oslwna. Pag* Inug* or Amicu*. DISCOVERY ZX DoJunes; 5'/. or 3vt * BaronData Data Dynamics Corporation POLK COURT REPORTERS C.,nf,J 2V.v/.. 80,006, L 77 Call Tbll-Free Outside California 800 533-5640 * Inside California 800 533-5641 FAX (213)625-1850 Local Telephone (213)625 7615 i 1 ! A Twenty years. i 2I Q And of these hundred and fifty times that 3 ' you have given testimony, would it be correct to say that 4 most of those have occurred within the last five to ten 5 years? 6 A Most have been in the last ten or eleven 7 years, yes. 8 Q And of the one hundred fifty or so times 9 that you have testified, what percentage of those one 10 hundred fifty times have been for the plaintiff? 11 A All but one or two. 12 Q What percentage over the last five years of 13 your income is made from medical-legal matters? 14 A 15 percent in the last five years. 15 Q How about in the last ten to eleven years? 16 A It would be considerably less than that. 17 Q What is your current hourly charge for 18 giving deposition testimony? 19 A $350 an hour. 20 MR. CARLSON: Just give me a few minutes 21 to -- 22 THE WITNESS: Sure. 23 MR. UNGLESBT: We can go on the record, in 24 case we have a problem with the Xerox, that Mr. Carlson 25 has requested Dr. Kilburn's file, and in the event it i 606 & Olive Street, Suite 307, Los Angeles, Calif. 90014-9976 QUORUM Worldwide Teleconlerer>Cng in our OfficerComputer transcription. Videctepmg. Key Word and Phrase indexing. SUBPOENA SERVICE IBM ASCII Diskettes, Page image or Amcua. 4> OlSCOVERY ZX Diskettes. 5% or 3'/* BaronData f Data Dynamics Corporation  80006 78 Call Tbll-Free Outside California 800 533-5640 Inside California 800 533-5641 FAX (213)625 1850 Local Telephone (213)625 7615 2V*"'TM 1 can't be copied at any kind of a reasonable time here, 2 I will go through it very quickly so it will be copied 3 and sent to Mr. Carlson. 4 We have a Confidential Asbestos 5 Questionnaire that consists of five pages. 6 You have a typed questionnaire that says 7 "L. G. Smith, 6/20/80, Physical Exam," consists of one, 8 two, three page; Pulmonary Associates, by Mr. D-a-t-t-a, 9 M.D. in Long Beach, California, three pages. 10 Physical and Behavioral Symptoms Inventory, 11 consists of multiple pages -12 THE WITNESS: No. It is just the top page. 13 MR. UNGLESBY: Well, behind it are -14 THE WITNESS: Notes, mostly. 15 MR. UNGLESBY: -- notes relating to all of 16 this from Metropolitan Life Insurance Company; 17 Clinical Neuropsychological Battery, 18 consisting of multiple pages; 19 Southern California Environmental Medical 20 Clinic admit sheets; 21 Oschner's Clinic, Release of Information 22 to Dr. Kilburn; letter from Dr. Kilburn to Michael 23 M-a-d-d-o-l-i-n at Metropolitan Life, which contains the 24 report written to me; a request from Metropolitan Life for 25 the report; 606 a Olive Street, Suite 307, Los Angeles, Calif. 90014-9976 ROW COURT REPORTERS OUORUM Wortdwid# Teleconferencing m our offices, Computer transcription Videotaping. Kay word and Phrase Indexing. $U8PONA SERVICE ISM ASCII OnkMiM. P BaronData,Psg* Imago or Arman. DISCOVERY TX OikmtM. 5v. or 3vi i Data Dynamics Corporation Call Tbll-Free Outside California 800 533-5640 Inside California 800 533-5641 FAX (213)625-1850 Local Telephone (213> 625-7615 80006 79 ! ii 1 ! I Southern California Environmental Medical 2 !i Clinic intake sheet; 3 j Dow Chemical health claim insurance form; 4 and a note that says "Polyarthritis due to vinyl 5 chloride." 6 And I will go and try to get them copied/ POIIC COURT REPORTERS C.,uf:.J 2> .M.n tUrUsv 7 but that way we know what they are in case we can't. 8 Q [By Mr. Carlson] Do you have anything else 9 that you have reviewed in connection with this case? 10 A Well, I have got a file like this on vinyl 11 chloride/ which/ you know, is that -- 12 Q Gesturing about eight inches thick? 13 A Yes. 606 S. Olive Street, Suite 307, Los Angeles, Calif. 90014-9976 14 Q Did you review that in preparation for your 15 deposition? 16 A Well, I looked through it really looking 17 for the information that I have testified about concerning 18 arthritis, Raynaud's phenomenon, acro-osteolysis, and so 19 forth. I just paged, looked through the file to pull out 20 anything that I thought was relevant to that issue because 21 I was curious after the x-rays arrived as to whether these 22 people had ever been followed up. 23 Q When you say the x-rays, those are the '86 24 and the '91s -- 25 A The ones -- t QUORUM VVWdwxJe Teteconleiencing in our office*. Computer tramcnpnon. Videotaping. Key Won) and Phrase Indexing. SUBPOENA SERVICE IBM ASCII Oakette* Pag* image or Amcus. * OfSCOVERY ZX Dtskenaa; 5V* or 3'4 BarunData Data Dynamics Corporation , 3 Of) 06 ** i* ' 80 Call Tbll-Free Outside California 800 533-5640 Inside California 800 533-5641 FAX (213)625 1850 Local Ifelephone (213)625 7615 1 Q -- x-rays? 2 A The one that Mr. Unglesby described that 3 he sent to me before this deposition. 4 Q When did you review those? 5 A Oh, I think it was two days ago. 6 Q That is the first time you saw them? 7 A Yes. 8 Q And just prior to this deposition, 9 plaintiff's counsel got here late, you had a meeting. 10 Could you tell us what you discussed? 11 MR. UNGLESBY: No, he can't. He can't. 12 It doesn't have anything to do with Lloyd Smith's cas . 13 It has to do with other cases in Louisiana, and he can't 14 discuss it. That's my work product. That is irrelevant 15 to this case. 16 Q [By Mr. Carlson] Did you discuss anything 17 pertainingto this case or vinylchloride? 18 A No. 19 Q Did he show you any documents pertaining to 20 this caseor vinyl chloride? 21 A No. 22 MR. CARLSON: I have nothing further. 23 MR. UNGLESBY: Thank you. That's all I 24 have. 25 [Discussion held off the record.] 606 & Olive Street, Suite 307, Los Angeles, Calif. 90014 9976 POLK COURT REPORTERS QUORUM Wonowoe Teleconferencing m our oftcM. Compuiw iranscnpion. Vtoeolaping, Key Word and Phrase indeung. SUBPOENA SERVICE IBM ASCII OsMitm, Page image or Amicua. DISCOVERY ZX Ookenes. 5v. or 3'y BaronData Data Dynamics Corporation 80006 81 MR. UNGLESBY: The stipulation in this vClMO>>7 case, in this deposition, from the Louisiana Code of Civil 3 i Procedure, by notice for perpetuation and trial testimony, ^ ; czj m* 4 and Dr. Kilburn will waive his right to read and sign the r -C irt AiSi>' <1n= cJ deposition. Say "That's right." V r -2 THE WITNESS; That's fine. 3\o 8 CO CioO Q9 MR. CARLSON: So stipulated. [At 12:45 p.m. the deposition was Q) 10 concluded.] *1 ICO 11 u-<dU 12 sj ! 13 to |oi4 '9?" SlO gg to15 = i16 c O CB -aSf M17 1318 <U 5 il9 C So,. eo a)20 fl 3 2 21 "(S <-8n = A03 22 S 23 O 5 24 55 25 QUORUM Wofltfwxfe Teteconfervnong m our offices. Computer transcription Videotaping. Key Word and Phrase indexing. Subpoena service IBM ASCII OsMnss. Pag* Imag* Ameu*. DISCOVERY ZX Dtsfcme*. Sv. or 3vy BaronDafa Data Dynamics Corporation * 80(506 ' Call Tbll-Free Outside California 800 533-5640 * Inside California 800 533-5641 FAX (213)625-1850 Local Telephone (213) 625-7615 POU COURT REPORTERS C^a/U REPORTER'S CERTIFICATE STATE OF CALIFORNIA ) COUNTY OF LOS ANGELES ) ss I, Nancy Maddux, CSR No. 4300, certify and declare: That the foregoing deposition of KAYE H. KILBURN, M.D. was taken before me pursuant to Notice at the time and place herein set forth, at which time the witness was put on oath by me; That the testimony of the witness and all objections made at the time of the examination were recorded stenographically by me and were thereafter transcribed; That it was stipulated by counsel and the witness that the signature of the witness to the said deposition be waived; and That the foregoing deposition as typed is a true record of the testimony of the witness and of all objections made at the time of the examination. I certify and declare under penalty of perjury of the laws of the State of California that the foregoing is tru and correct. IN WITNESS WHEREOF, I have subscribed my name this 17th day of August, 1991. 606 & Olive Street, Suite 307, Los Angeles, Calif. 90014-9976 QUORUM Worldwide leiecontorencing m our offices. Computer transcription. Videotaping. Key Won) and Ptirase Indexing. SUBPOENA SERVICE IBM ASCII Diskettes, Page Image or Amicus. DISCOVERY ZX Diskettes; 514 or 3W BaronData Data Dynamics Corporation row COURT REPORTERS C^ufiJ G*M> S. Olive Street, Suite 307, law Angeles, Calif. 90014 fajcal Telephone (213) 625 761 ('all Tull Free Outside California 800 533 5640 Inside California 800 533 50-11 5/ CURRICULUM VITAE KAYE H. KILBURN, M.D. Present Position: Office Address: Home Address: Born: Marital Status: Education: Postgraduate Training S.S.# 529-36-6955 Ralph Edgington Professor of Medicine, University of Southern California School of Medicine Director of Environmental Sciences Lab, 1980. Director, Workers Disease Detection Services, 1987- Editor-in-Chief, Archives of Environmental Health, 1986. 2025 Zonal Ave., RB-1 Room 226 Los Angeles, CA 90033 (213) 224-7514 3250 Mesaloa Lane Pasadena, CA 91107 (818) 794-4579 September 20, 1931 - Logan, Utah Married Gerrie Griffin, 1954 Three children University of Utah, B.S. (Honors), 1951. University of Utah, School of Medicine, M.D., 1954. Rotating Intern, St. Mark's Hospital, Salt Lake City, Utah April - June, 1954. Intern-Medicine, University Hospitals, Cleveland, Ohio, 1954-55. Assistant Resident-Medicine University of Utah Hospitals Salt Lake City, Utah, 1955-56. Resident-Pathology and Medicine, Veterans Administration Hospital, Salt Lake City, Utah, 1956-57. Research Fellow in Medicine, Duke University Hospital, Durham, North Carolina, 1957-58. American Trudeau Society Research, Fellow, 195a. <svi Postgraduate Training Cont: U.S.P.H.S. Research Fellow with Dr. Paul Wood, Cardiac Department, Brompton Hospital, London, England, 1960-61. Sabbatical, 1968-Cell biology and ultrastructure, J. David Robertson, M.D., Professor of Anatomy, Duke University, U.S.P.H.S. Special Fellowship. Research Career Development Award, NIEHS, 1969-1973. Certified American Board of Internal Medicine, 1963. American Board of Preventive Medicine (Occupational Health) 1983. Military Service: Chief. Suroerv Branch. Physiology Division. U.S. Army Medical Research and Nutrition Laboratory. Fitzsimmons General Hospital. Denver,. Colorado. 1958-60. Academic Positions Held: Clinical Instructor in Medicine, University of Colorado, 1959-60. Senior Registrar in Cardiology Department, Brompton Hospital, London University, 1960-61. Instructor in Medicine, Director. Cardiopulmonary Division. Washington .University School of Medicine. 1960-62. Assistant Professor, Washington University, 1962. Assistant Physician, Barnes Hospital, St. Louis, Missouri, July, 1961-62. Associate Professor of Medicine, Duke University, 1962-69. Chiefl._Medical Service. Veterans Administration Hospital. Durham. North Caroline 1963-68. Director.-Division of_Environmental Medicine. Department of Medicine. Medical Center. 1968-73. Consultant, Durham Veterans Administration Hospital, Fayetteville Veterans Administration and oteen Veterans Administration Hospital, North Carolina, 1968-73. Recipient of Research Career Development Award 1-K4-ES-8111 from the National Institute of Environmental Health Sciences, June, 1969. Associate Professor of Medicine and Assistant Professor of Anatomy, Duke University, 1969-70. Professor of Medicine and Assistant Professor of Anatomy, Duke University, 1970-73. Professor of Medicine, Associate Professor of Anatomy, University Of Jtissonri-CQlumbia 1973-77. Director. Division of Pulmonary and Environmental Medicine. 1973-77. 2 Academic Positions Held Cont'd: Professor of Medicine and Professor of Community Medicine, Environmental Sciences Lab, Mt. Sinai School of Medicine, 1977-80 Professor of Medicine, University of Southern California, 1980-. Director, Barlow Occupational Health Center, 1982-1984. Chief, Pulmonary and Environmental Medicine Section LAC-USC Medical Center, 1982-1984. Administrative Experience; 1958-1960 1960-1961 1961-1962 1962-1968 1968-1973 1973-1977 1977-1980 1980-1984 1980-Present Directed surgical Division of U.S. Army Medical Research and Nutrition Laboratory - Fitzsimons General Hospital, Denver, Colorado. Senior Registrar British Health Service, Brompton Hospital, University of London. Director, Division of Cardio-respiratory Medicine, Washington University, St. Louis, MO. Chief, Medical Services, Durham Veterans Administration Medical Center of Duke University Medical Center, Durham, NC. Director, Division of Environmental Medicine, Duke University Medical Center, Durham, NC. Director, Pulmonary and Environmental Medicine Division, Department of Medicine, University of Missouri-Columbia, Columbia, MO. Chief of Research, Pulmonary Division, Member Environmental Sciences Laboratory and Chief, Pulmonary Disease Service, Bronx VA Hospital, Mount Sinai School of Medicine. Founding Director, Barlow Occupational Health Center, University of Southern California, Los Angeles, ca. Director, Environmental Sciences Laboratory, Department of Medicine, University of Southern California, Los Angeles, CA. President and Medical Director, Workers Disease Detection services Inc., San Dimas, CA. Professional Societies; American Association for Advancement of Science. American Medical Association. American Thoracic Society, Committee on Therapy 1965-67; Nomenclature Committee 1972. American Federation for Clinical Research. Southern Society for Clinical Investigation. American Physiological Society. American Heart Association. Sigma xi. Professional Societies Cont'd; American Occupational and Environmental Health Society. American Society for Experimental Pathology. Central Society for Clinical Research. American Society for Cell Biology. International Epidemiological Association. American Public Health Association. Western Association of Physicians. Collegium Ramaz2ini. National Committees: Member, Veterans Administration Pulmonary Disease Research Evaluation Committee, 1963-69. Member, Veterans Administration Cardiopulmonary Training Committee, 1968-75. Member, American Thoracic Society Committee on Anti-Smoking, 196972. Member, National Air Conservation Commission, 1970. Member, Lung Center Grant Review Committee, National Heart and Lung Institute, 1971. Member, Ad Hoc Air Pollution Control Office Research Grant review Committee, 1971. Member, Pulmonary Academic Award Committee, NHLI, 1974-76. Member, Research Evaluation Committee, National Cystic Fibrosis Society, 1974-78, Education Committee, 1977-78. Member, Advisory Committee to Surgeon General on Paraquat and other Herbicides, on Marijuana, 1978. Scientific Advisor to Workers' Institute for Safety and Health 1979. Member, Committee on Byssinosis, Assembly on Life Sciences, National Research Council, 1979-1981. Member, Board of Scientific Counselors, Division of Cancer Prevention and Control, National Cancer Institute, 1980. Education Activities: Microanatomy course - first year medical curriculum, Duke University. General medicine - second year ward and outpatient attending. Lung Pathology - third year. Environmental Medicine Course (Director) - third year. Environmental Lung Seminar. Pulmonary Medicine - fellows and residents. 4 Symposia Director: 1. Symposium on Structure, Function and Measurement of Respiratory Cilia, Duke University, February 12-14, 1965. Amer. Rev. Resp. Dis. 93: (part 2) 1-194, 1966. 2. An evaluation of Model Systems for Studying the Pulmonary Responses to Inhaled Materials, Bermuda, October 19-21, 1969, Arch. Ittt, Med. 126:415-511, 1970. r 3. Pathogenesis of Byssinosis and Related Vegetable Dust Diseases, Quail Roost, North Carolina, April 1-May 1, 1970. 4. Cotton Dust and Health, Charlotte, North Carolina, May 2, 1970. 0 5. Hanford conference on Pollution and Lung Biochemistry, Richland, Washington, June 3-6, 1970. 6. New York Academy of Sciences Symposium on Pulmonary Reactions to Organic Materials, New York city, November 8-11, 1972. r 7. Tobacco Smoke Effects on the Non-Smoker, Bermuda, March 2729, 1974, Co-Director with Dr. Ragnar Rylander. 8. Asbestos Associated Disease, New York city, November 27-29, 1978, Co-Director with Dr. Irving J. Selikoff. C 9. International Meeting Monitoring of Exposure to Selected Chemicals and Their Health Effects, Berlin, West Germany, December 13-17, 1982. 10. Chronic Disease in the Workplace and Environment, Workplace C Health Fund, Washington, D.C., November 30 - December 1, 1983. 11. International Conference on Health Hazards and Biological Effects of Welding Fumes and Gases. Cogenhagen, October 812, 1984. WHO-CEC (Planning Committee). G Editorial Responsibilities: Editorial Board: American Journal of Physiology, 1973-75. C. Archives of Environmental Health, 1970-76. Executive Editor, 1976-85. Editor in Chief. 1986. Environmental Research, 1970. Journal of Applied Physiology, 1973-76. 5 Associate Editor: American Journal of Industrial Medicine, 1980- Guest Editor: American Heart Journal. American Review of Respiratory Disease. Annals of internal Medicine. Chest. Journal of Clinical Investigation. CAREER RESUME Kaye H. Kilburn, M.D. Dr. Kilburn received his medical degree from the University of Utah College of Medicine in 1954. He completed postgraduate training in internal medicine at Western Reserve University (internship). University of Utah Hospitals (residency in Medicine and in Pathology), and Duke University (fellowship in cardio pulmonary disease). In 1958, he developed a cardiopulmonary research laboratory with staff of 15 at the U.S. Army Medical Research and Nutritional Laboratory at Fitzsimmons Army Hospital. Both human and animal research was done and six papers were published. Following these two years, he devoted a year to clinical cardiology training with the late Dr. Paul Wood in London, England. He returned to the United States in 1961 to organize the first cardiopulmonary division for Washington University (at Barnes Hospital), st. Louis. His effect on the house staff was measured by 5 of 20 interns going into pulmonary disease including Dr. Robert Senior, now Chief of Pulmonary Disease, Washington University (Jewish Hospital of St. Louis). He accepted the challenge from Dr. Eugene stead to return to Duke in 1963 to organize and head the medical service of the Durham Veterans Administration as an integral partner with Duke Hospital Faculty were attracted and housestaff training was emphasized. A cardiology section was strengthened and a pulmonary section created including intensive care and research laboratories. Studies ranged from a prospective pathophysiological study of respiratory failure to clearance mechanisms of the lung and ciliary beating. This five year administrative period was balanced by a sabbatical in ultrastructure of the lung with David Robertson in anatomy at Duke. A new and novel division of Environmental Medicine was developed and organized by Dr. Kilburn at Duke from 1968-73. Its breadth extended from epidemiology of textile workers' lung disease (byssinosis) in cooperation with the North Carolina Department of Health and Burlington, the textile giant, to the basic biology of ciliary beating, lung surfactant, glycoproteins of alveolar proteinosis and effects of inhalants such as cotton dust and cigarette smoke on airway lining cells. The division became a model for scientific solving of societal problems. It had a faculty of 12 and a staff of 25. Ten M.D.'s and Ph.D.'s were trained in environmental medicine including James A. Merchant, M.D., who received a doctorate in Public Health and presently heads the Appalachian Laboratory for NIOSH at Morgantown, West Virginia, and Michael Passero, M.M., head of pulmonary disease at 7 the University of Rhode Island, and Daniel J; Hurst, head of pulmonary disease at the University of Missouri. In 1973, Dr. Kilburn went to the University of Missouri to establish the first pulmonary and envirnmental medicine program. A faculty of six M.D.'s and three Ph.D.'s established full diagnostic services, intensive care, a pulmonary fellowship program, research in connective tissue of lung in response to inhalants and on the causal agent of byssinosis, and a satellite pulmonary training program at the state Chest Hospital with full services. In 1977, Dr. Kilburn returned to society's environmental and occupational medicine frontier by joining Dr. Irving J. Selikoff in the Environmental Sciences Laboratory at Mt. Sinai School of Medicine in New York. Among his roles was the development of strong "mechanisms of diseases" laboratories as partner to the epidemiological laboratories and encourage basic scientists to attach environmental and occupational health problems. Two of the new programs are addressed to the questions: "Is the lung in utero sensitive to chemical toxins?" and "What is the role of the lungs' proteases in interstitial diseases?" In 1980, Dr. Kilburn accepted the Ralph Edgington Chair in Medicine at the University of Southern California School of Medicine. The causes of disease in occupational and environmental sectors are the concern of the Environmental Sciences Laboratory under his direction. In August of 1980, the Barlow-USC Occupational Health Center was founded as a clinical center for the investigation of the adv rse health effects of environmental agents. Current projects include control of lung cancer in shipyard workers, asbestos disease in families of shipyard workers, the adverse health effects of welding, the toxicity of fiberglass, the toxicity of formaldehyde in resin users and in histology technicians, histochemical methods for cytology, laboratory models for birth defects and the development of health surveillance programs for workers. The Pulmonary Division at USC School of Medicine and Los Angeles County-USC Medical Center, with its responsibilities for education, research and patient care, came under Dr. Kilburn's direction in July, 1982. The objectives of this division are clinical investigations of adult respiratory distress syndrome, and of asthma with emphasis on inflammatory responses in the lung. There is a faculty of 12 physicians. The facilities include a 38 bed clinical chest unit with 4 intensive care beds at LAC-USC Medical Center and 50 beds with 6 ICU beds at Barlow Hospital. Research accomplishments during the 1980-1985 interval included studies of shipyard workers and their household exposed family 8 s members, showed a sizable proportion of wives (11.3%) had signs of asbestosis. These women and their daughters also showed airflow reductions in nonsmokers attributed to Los Angeles air pollution. The repeat study of 330 of these women in June, 1985, four years after the initial study, which is now being analyzed, expected to show further changes due to environmental smog. A sample of 1,225 Los Angeles school children in 2nd and 5th grades was studied by spirometry and questionnaire for the prevalence of asthma, chronic bronchitis, response to bronchodilators, and effects of household cigarette smoking and smog. In these children, asthma had a prevalence of 6.8% by parental criteria, of 8.3% by physician diagnosis, while 6.6% had wheezing on examination. A longitudinal study of pulmonary and neurobehavioral effects of formaldehyde shows no evidence of chronic effects on pulmonary function. In fact, the study yields the first useful national group of women. However, 6 of 10 tests in a neurobehavioral battery were reduced when regression analysis was done against hours of formaldehyde (age reduced 8 of 10 tests). A cross-shift study of welding has shown that stainless steel reduces flow rates during work, but more disturbing, welders had forced vital capacities and forced expiratory volume in 1 sec, 10% below predicted in both nonsmokers and smokers, compared to-a smoking specific reference population. Studies continue of effects of asbestos, formaldehyde and solvent exposure, and welding fumes. Ongoing studies of the effects of chemicals on lung and organ development began in 1974, show further evidence of growth delaying effects of copper deficiency and agents which affect elastin and collagen cross-linking, including disulfuram, betaarainoproprionitrite, and a bis (dichloroacetyl) diamine WIN 18,446. 9 c: j Kaye H. Kilburn. M.D, MANUSCRIPTS PUBLISHED 1. Kilburn KH: Massive hepatomegaly and an elevated serum acid phosphatase associated with a retrovesical carcinoma. Cancer 11:363-368, 1958. 2. Kilburn KH: Secondary amyloidosis and hepatic failure in Hodgkin's disease. Am J Med 24:654-658, 1958. 3. Kilburn KH and Brown H: Anasarca and hypoproteinemia in reticulum cell sarcoma. Ann Intern Med 49:1257-1266, 1958. 4. Kilburn KH: The innocuousness and possible therapeutic use of aerosol amphotericin-B. Am Rev Respir Dis 80:441-442, 1959. 5. Kilburn KH, Eagan JT and Heyman A: Cardiopulmonary insufficiency associated with myotonic dystrophy. Am J Med 26:929-935, 1959. 6. Kilburn KH, Eagan JT, sieker HO and Heyman A: Cardiopulmonary insufficiency in myotonic and progressive muscular dystrophy. N Eng J Med 261:1089-1096, 1959. 7. Kilburn KH: The dimensional responses of bronchi in apneic dogs to airway pressure, gases and drugs. J Appl Physiol 15:229-234, 1960. 8. Kilburn KH and Sieker HO: Hemodynamic effect of continuous positive and negative pressure breathing in normal man. Circ Res 8:660-669, 1960. 9. Kilburn KH, MacDonald J and Piccinni FP: Effects of ventilatory pattern and body position on lung volume in dogs. J Appl Physiol 15:801-806, I960. 10. Kilburn KH: Effect of adrenergic blockage with hydergine on hyperglycemia accompanying hypothermia in dogs. Am J. Physiol 199:955-958, 1960. 11. Kilburn KH and Schmidt AM: Intrathoracic Plasmacytoma. Arch Intern Med 106:862-869, I960. 12. Kilburn KH, Miller HA, Burton JE and Rhodes R: Effects of altering ventilation on the steady-state diffusing capacity for carbon monoxide. J Appl Physiol 18:89-96, 1963. 10 13. Kilburn KH: Cardiorespiratory effects of large pneumothorax in conscious compared with anesthetized dogs. J Appl Physiol 18:279-283, 1963. 14. Kilburn KH: Tachypnea and hyperpnea: signs of compensatory ventilation. Ann Intern Med 62:486-498, 1965. 15. Kilburn KH: Neurologic manifestations of acute respiratory failure. Arch Intern Med 116:409-415, 1965. 16. Kilburn KH and Salzano JV: Respiratory cilia. Science 148:1618-1619, 1976. 17. Kilburn KH: Percutaneous arterial catheterization for blood sampling. Am Rev Resp Dis 92:293-294, 1965. 18. Kilburn KH: Muscular origin of elevated plasma potassium during exercise. J Appl Physiol 21:675-678, 1966. 19. Kilburn KH: Movements of potassium during acute respiratory acidosis and recovery. J Appl Physiol 21:679-684, 1966. 20. Kilburn KH and Salzona JV, eds: Symposium on structure, function and measurement of respiratory cilia. Am Rev Respir Dis 93:1-184, 1966. 21. Kilburn KH: shock, seizures, and coma with alkalosis during mechanical ventilation. Ann Intern Med 65:977-984, 1966. 22. Kilburn KH: cilia and mucus transport as determinants of the lung to air pollutants. In: AMA Air Pollution Medical Research Conference, Los Angeles, California, March 2-4, 1966. Arch Environ Health 14:77-91, 1967. 23. Kilburn KH: Principles of respiratory care. A statement by the committee on therapy, American Thoracic Society. Am Rev Respir Dis 95:327-337, 1967. 24. Kilburn KH: Pathogenesis and treatment of chronic bronchitis. Med Times 95:161-176, 1967. 25. Kilburn KH: Mucociliary clearance from bullfrog (Rana Catesbiana) lung. J Appl Physiol 23:804-810, 1967. 26. Kilburn KH: Clearance from alveoli to the ciliary escalator: implications for pulmonary diseases. 10th Aspen Conference in Research on Emphysema, Aspen, Colorado, June 6-10, 1967. Current Research in Chronic Obstructive Lung Disease: Proceedings Tenth Aspen Emphysema Conference (PHS Publication No. 1787). 11 27. Kilburn KH: Smoking. A statement by the committee on therapy, American Thoracic Society. Am Rev Respir Dis 96:613-622, 1967. 28. Kilburn KH: Theory and models for cellular injury and clearance failures in the lung. In: Symposium on the Development of Animal Model Systems for the Study of the Etiology of Emphysema and Other Chronic Obstructive Respiratory Diseases, La Jolla, California, October 6-7, 1967. Yale J Biol Med 40:339-351, 1968. 29. Kilburn KH: A hypothesis for pulmonary clearance and its implications. Am Rev Respir Dis 98:449-463, 1968. 30. Kilburn KH: Alveolar clearance of particles, a bullfrog lung model. Arch Environ Health 18:556-563, 1969. 31. Kilburn KH and Asmundsson T: Anteroposterior chest diameter in emphysema from maxim to measurement. Arch Intern Med 123:378-382, 1969. 32. Asmundsson T and Kilburn KH: Survival of acute respiratory failure. Ann Intern Med 70:471-485, 1969. 33. Asmundsson T and Kilburn KH: Complications of acute respiratory failure. Ann Intern Med 70:487-495, 1969. 34. Kilburn KH, Asmundsson T, Britt RC and Cordon R: Effects of breathing 10% CO2 on the pulmonary circulation in human subjects. Circulation 39:639-653, 1969. 35. Kilburn KH and Rylander R: An evaluation for model systems for studying the pulmonary responses to inhaled materials. Am Rev Respir Dis 101:632-638, 1969. 36. Karpick RJ, Pratt PC, Asmundsson T and Kilburn KH: Pathological findings in respiratory failure: goblet cell metaplasia, alveolar damage and myocardial infarction. Ann Intern Med 72:189-197, 1970. 37. Pratt PC and Kilburn KH: A modern concept of the emphysemas based on correlations of structure and function. Hum Pathol 1:443-463, 1970. 38. Kilburn KH: Alveolar micro-environment. Arch Intern Med 126:435-449, 1970. 39. Asmundsson T and Kilburn KH: Mucociliary clearance rates at various levels in dog lungs. Am Rev Respir Dios 102:388-397, 1970. 12 40. Pratt PC and Kilburn KH: Roentgenographic methods for the anatomic diagnosis of emphysema. Ann Intern Med 73:134-135, 1970. 41. Kilburn KH: Human costs of pulluted air. Med Times 98:156170, 1970. 42. Kilburn KH: Guest Editor, Prologue: Impressions of the workshop as communication. Arch Intern Med 126:415-416, 1970. 43. Kilburn KH and Rylander R: An interpretative summary of the Bermuda workshop. Arch Intern Med 126:508-511, 1970. 44. Nagaya H, McKenzie WN, Kilburn KH and Sieker HO: Immunosuppressive potency of antiserum to thymus glands prepared with ribosomal fraction. J Immunol 103:511-513, 1970. 45. Kilburn KH and Dowell AR: Connective tissue of the lung. Arch Intern Med 127:845-846, 1971. 46. Harris TR, Pratt PC and Kilburn KH: Total lung capacity measured by roentgenograms. Am J Med 50:756-763, 1971. 47. Dowell AR, Kilburn KH and Pratt PC: Short-term exposure to NC>2. Arch Intern Med 128:74-80, 1971. 48. Kilburn KH, Dowell AR and Pratt PC: Morphological and biochemical assessment of papain emphysema. Arch Intern Med 127:884-890, 1971. 49. Kilburn KH and Dowell AR: Renal function in respiratory failure, effects of hypoxia, hyperoxia and hypercapnia. Arch Intern Med 127:754-762, 1971. 50. Asmundsson T, Kilburn KH, Laszlo J and Krock CJ: Immunosuppressive therapy of asthma. J Allergy 47:136-147, 1971. 51. Nagaya H, McKenzie WN, Kilburn KH and sieker HO: Immunosuppressive effects of antisera prepared with subcellular fractions of thymus, spleen and lymph nodes. Transplantation 12:384-388, 1971. 52. Ayer HE, Battigelli M, Fraser DA, Hamilton JD, Kilburn, KH, Lumsden J, Lynch JR, Merchant JA and Stevens AD: The status of byssinosis in the United States. Arch Environ Health 23:230-234, 1971. 13 53. Pratt PC and Kilburn KH: Extent of pulmonary pigmentation in autopsied human lungs as an indicator of particulate environmental air pollution. In: Inhaled Particles and Vapours III. Edited by W.H. Walton. Vol. 2, Surrey (England). Unwin Brothers Ltd., pp 661-670, 1971. 54. Merchant JA, Kilburn KH, O'Fallon WM, Hamilton JD, Lumsden JC, Drake BM, Rausch DC, Carstens CJ and Byrd HL: Byssinosis and chronic bronchitis among cotton textile workers. Ann Intern Med 76:423-433, 1972. 55. Harris TR, Merchant JA, Kilburn KH and Hamilton JD: Byssinosis and respiratory diseases of cotton mill workers. JOM 14:199-206, 1972. 56. Kilburn KH: A critique on epidemiologic methods used to study chronic pulmonary disease. Przcglad Lekarski 29:529533, 1972. 57. Kilburn KH, Merchant JA, Lumsden J and Hamilton JD: Chronic bronchitis in cotton textile workers; evidence for addition of effect of cigarette smoking and occupational exposure, in: Ecology of Chronic Nonspecific Respiratory Diseases. Edited by Z. Brzezinski, J Kopczynski, F. Sawicki. Warsaw: Panstwowy Zakland Wydawnictw Lekarskich, Chapt. 2, p. 76, 1972. 58. Macklem PT and Kilburn KH: Tracheal bronchial response to insult. In: Environmental Factors in Respiratory Disease. Edited by Douglas H. Lee, New York, Academic Press, Chapter 3, 1972. 59. Kilburn KH: Modes of alveolar response to insult. In: Environmental Factors in Respiratory Disease. Edited by Douglas H. Lee, New York, Academic Press, Chapter 4, 1972. 60. Kilburn KH and Dowell AR: Renal function in respiratory failure: effects of hypoxia, hyperoxia and hypercapnia. Condensed article published in ICU (Upjohn Company publication), 1972. 61. Kilburn KH: Environmental medicine. Medical Tribune and Medical News, Vol 13, No. 32, August 16, 1972, and No. 34, September 6, 1972. 62. Hurst DJ, Kilburn KH and Lynn WS: Isolation and surface activity of soluble alveolar components. Respir Physiol 17:72-80, 1973. 63. Hamilton JD, Halprin GM, Kilburn KH, Merchant JA and Ujda JR: Differential endobronchial challenge studies in byssinosis. Arch Environ Health 26:120-124, 1973. 14 64. Kilburn KH and Asmundsson T: Anatomy of the mucociliary apparatus. In: Sputum: Fundamentals and Clinical Pathology. Edited by M. Dulfano. Springfield: Charles C. Thomas, Chapt. 3, pp. 69-106, 1973. 65. Asmundsson T and Kilburn KH: Mechanisms of respiratory tract clearance. In: Sputum: Fundamentals and Clinical Pathology. Edited by M. Dulfano. Springfield: Charles C. Thomas, Chapt 4, pp. 107-180, 1973. 66. Kilburn KH, Lynn WS, Tress LL and McKenzie WN: Leukocyte recruitment through airway walls by condensed vegetable tannins and quercetin. Lab Invest 28:55-59, 1973. 67. Hamilton JD, Germino VH, Merchant JA, Lumsden JC and Kilburn KH: Byssinosis in a non-textile worker. Am Rev Respir Dis 107:464-466, 1973. 68. Asmundsson T, Johnson RF Jr, Kilburn KH and Goodrich JK: Efficiency of nebulizers for depositing saline in human lung. Am Rev Respir Dis 108:506-512, 1973. 69. Kilburn KH: Biological effects of cigarette smoking in the pathogenesis of pulmonary disease. JOM 15:198-201, 1973. 70. Merchant JA, Lumsden JC, Kilburn KH, O'Fallon WM, Ujda JR, Germino VH and Hamilton JD: An industrial study of the biological effects of cotton dust and cigarette smoke exposure. JOM 15:212-221, 1973. 71. Merchant JA, Lumsden JC, Kilburn KH, o'Fallon WM, Ujda JR, Germino VH and Hamilton JD: Dose response studies in cotton textile workers. JOM 15:222-230, 1973. 72. Passero MA, Tye RW, Kilburn KH and Lynn WS: Isolation and characterization of two glycoproteins in alveolar proteinosis. Proc Nat'l Acad Sci USA 70:973-976, 1973. 73. Asmundsson T, Kilburn KH and McKenzie WN: Injury and metaplasia of airway cells due to SO2- Lab invest 29:41-53, 1973. 74. Kilburn KH: Mechanisms of pulmonary injury and repair. In: Fundamental Problems of Cystic Fibrosis and Related Diseases. Edited by J Mangos and R.C. Talamo. New York, Intercontinental Medical Book Co., pp. 129-172, 1973. 75. Kilburn KH and Asmundsson TA: Factors influencing the course of chronic obstructive pulmonary disease. Postgrad Med 54:135-141, 1973. 15 r r .. C 76. Kilburn KH, Kilburn GG and Merchant JA: Byssinosis: matter, from lint to lungs. Am J Nurs 73:1952-1956, 1973. 77. Asmundsson T and Kilburn KH: Farmers lung. Mo Med 70:597599, 1973. 78. Merchant JA, Lumsden JC, Kilburn KH, Germino VH, Hamilton JD, Lynn WS, Byrd H and Baucom D: Preprocessing cotton to prevent byssinosis. Br J Ind Med 30:327-347, 1973. 79. Kilburn KH: Functional morphology of distal lung. Edited by G. Bourne and J. Danielli. Int Rev Cytol 37:153-270, 1974. 80. Kilburn KH: Clearance zones in the distal lung. Ann NY Acad Sci 221:276-281, 1974. 81. Merchant JA, Halprin GM, Hudson AR, Kilburn KH, McKenzie WN Jr, Bermanzohn P, Hurst DJ, Hamilton JD and Germino vh Jr: Evaluation before and after exposure - the pattern of physiological response to cotton dust. Ann NY Acad Sci 221:38-43, 1974. 82. Kilburn KH: Acute Bronchitis due to cotton plant polyphenols. Ann NY Acad Sci 221:335-339, 1974. 83. Asmundsson TA and Kilburn KH: survival after acute respiratory failure: 145 patients observed 5 to 8-1/2 years. Ann Intern Med 80:54-57, 1974. 84. Sullivan T and Kilburn KH: Complications in the course of asthma. In: Bronchial Asthma: Mechanisms and Therapeutics. Edited by M.S. Segal and E.B. Weiss. Boston, Little, Crown & Company, 1974. 85. Hudson AR, Halprin GM, Miller JA and Kilburn KH: Pulmonary interstitial fibrosis following alveolar proteinosis. Chest 65:700-702, 1974. 86. Kilburn KH, Hudson AR, Halprin GM, McKenzie WN and Merchant JA: Two patterns for bronchial damage from inhaled materials, chest 65:6ls-62s, 1974. 87. Kilburn KH: Genetics and biochemistry. Bull Physiol Pathol Resp 10:540-549, 1974. 88. Kilburn KH: Effects of tobacco smoke on biological systems. Scand J Respir Dis (Suppl) 97:63-78, 1974. 89. Merchant JA, Lumsden JC, Kilburn KH, O'Fallon WM, Germino vh, McKenzie WN, Baucom D, Currin P and Stilman J: Intervention studies of cotton steaming to reduce biological effects of cotton dust. Br J ind Med 31:261-274, 1974. 16 90. Kilburn KH: New clues for the emphysemas. Am J Med 58:591600, 1975. 91. Adshead PC, Martinez JR, Kilburn KH and Hess RA: Ciliary inhibition and axonemal microtubule alterations in freshwater mussels. Ann NY Acad Sci 253:192-212, 1975. 92. Merchant JA, Halprin GM, Hudson AR, Kilburn KH, McKenzie WN, Hurst DJ and Bermanzohn P: Responses to cotton dust. Arch Environ Health 30:222-229, 1975. 93. Kilburn KH, McKenzie w and Thurston R: Cellular effects of cigarette smoke on hamster airways. Chest 67:54s-55s, 1975.: 94. Kilburn KH and McKenzie W: Leukocyte recruitment to airways by cigarette smoke and particle phase; cytotoxicity of vapor. Science 189:634-637, 1975. 95. Hess RA, Thurston RJ and Kilburn KH: Enzyme digestion of epon embedded akinetic cilia. Proc Electron Microscopy Soc. Amer. 33rd meeting, 1975, Baton Rouge, LA., Claitorfs Publishing Div., pp. 688-689, 1975. 96. Kilburn KH: Genetic and biochemical clues for emphysema: Implications for early diagnosis. Prog Resp Res (Karger, Basel) 8:31-60, 1976. 97. Thurston RJ, Hess RA, Kilburn KH and McKenzie WN: Ultrastructure of lungs fixed in inflation using a new osmium-fluorocarbon technique. J Ultrastruct Res 56:39-47, 1976. 98. Kilburn KH: Clearance mechanisms in the respiratory tract. In: Handbook of Physiology, Section 9: Reactions to Environmental Agents 243-263, 1977. 99. Hurst DJ, Kilburn KH and Baker WM: Normal newborn and adult human lung collagen-analysis of types. Connective Tissue Res 5:117-125, 1977. 100. Hudson AR, Kilburn KH, Halprin GM and McKenzie WN: Granulocyte recruitment to airways exposed to endotoxin aerosols. Am Rev Respir Dis 115:89-95, 1977. 101. Kilburn KH, Hess RA, Thurston RJ and smith T: Ultrastructural features of osmotic shock in mussel gill cilia. J Ultrastruct Res 60:34-43, 1977. 17 102. Northrup SC and Kilburn KH: Role of mycotoxins in human pulmonary disease. In: Handbook on Mycotoxins and Mycotoxicoses. Edited by L.G. Morehouse and T.D. Wyllie. New York: Marcel Dekker, Inc., pp. 91-108, 1978. 103. Kilburn KH: Model systems for the biological effects of air pollutants. Proceedings of the Twentieth Annual "OHOLO'* Biological Conference in Ma'alot, Israel, Air Pollution and the lung. John Wiley and Sons, New York, 1978. 104. O'Dell BL, Thurston RJ, McKenzie WN and Kilburn KH: Copper deficient rat lung as a model for emphysema. Am J Pathol 91:413-432, 1978. 105. Kilburn KH: Pulmonary diseases induced by drugs. In: Pulmonary Diseases. Edited by A.P. Fishman. New York: McGraw-Hill, 1979. 106. Kilburn KH, Lynn DG, McCormick JP and Schafer TR: Effects of synthetic lacinilene C-7 methyl ether on hamster airways. Proceedings of the National Cotton Council, Jan. 8-11, 1979. 107. Lesser M, Einstein KH, Shah R and Kilburn KH: Right pulmonary mass in a patient with mitral valve prothesis. Chest 76:681-682, 1979. 108. Kilburn KH: Pulmonary responses to organic materials: Occupational asthma, byssinosis, farmer's lung and granulomatous alveolitis. In: Maxcy-Rosenau Public Health and Preventive Medicine. 11th edition, editor J. Last, i960. 109. Kilburn KH: Diseases caused by asbestos. Icelandic Med J 66:38-40, 1980. 110. Kilburn KH: strategies for controlling occupational lung disease. Icelandic Med J 66:78-80, 1980. 111. Kilburn KH, Lesser M and McCormick J: The relevance of laciniline C7-methyl ether to byssinosis. Experience with the natural product from bracts and the synthetic chemical in leukocyte recruitment. Chest 79(Suppl):58s-6ls, 1981. 112. Orlowski M, Orlowski J, Lesser M and Kilburn KH: Proteolytic enzymes in bronchopulmonary lavage fluids: Cathepsin B-like activity and prolyl endopeptidase. J Lab Clin Med 97(4):467476, 1981. 113. Kilburn KH: Byssinosis 1981: A commentary. Am J Ind Med 2:81-88, 1981. 114. Kilburn KH: Lung cancer: Time for a new strategy? Urban Health 10(15):467-477, 1981. 18 115. Kilburn KH: Byssinosis: Diagnosing airway obstruction in textile workers. J Respir Dis 2(12):87-96, 1981. 116. Kilburn KH: Cigarette smoking does not produce or enhance radiological pulmonary fibrosis. Am J Ind Med 2:305-308, 1981. 117. Kilburn KH: Chronic bronchitis and emphysema. Chapter for Occupational Pulmonary Disease, a NIOSH Task Force report, USPHS, edited by J.A. Merchant and G. Taylor, 1982. 118. Lesser M and Kilburn KH: Recruitment of inflammatory and immunologically competent cells. In: Mechanisms in Respiratory Toxicology, vol. 2. P. Nettesheim, editor, crc, 1982. 119. Kilburn KH: Byssinosis: A minority report. National Research Council, Committee on Byssinosis, Division of Medical Scien ces, Assembly of Life Sciences, National Research Council. In: Byssinosis: A Clinical and Research Issue. National Academy Press, Washington, D.C., pp. 133143, 1982. 120. Kilburn KH: Flamue attenuated fiberglass: another asbestos? Am J Ind Med 3:121-125, 1982. 121. Kilburn KH and Hess RA: Neonatal deaths and pulmonary dysplasia due to d-penicillamine in the rat. Teratology 26:1-9, 1982. 122- Kilburn KH, Hess RA, Lesser M and Oster G: Perinatal death and respiratory apparatus dysgenesis due to a bis (dichloroacetyl) diamine. Teratology 26:155-162, 1982. 123. Kilburn KH: Respiratory symptoms due to paint exposure. In: Advances in Modern Experimental Toxicology. Occupational healths hazard of solvent, Volume II, Edited by A. Englund, K. Ringen, M.A. Mehlman. Princeton, New Jersey: Princeton Scientific, 1982. 124. Kilburn KH: Byssinosis and other diseases among textile workers. In: Environmental and Occupational Medicine. William N. Rom, Editor, Little, Brown and Company, Boston, pp. 207-214, 1983. 125. Oster G, Kilburn KH and Siegal FP: Chemically induced congenital thymic dysgenesis in the rat: A model of the DiGeorge Syndrome. Clin Immunol Immunopathol 28:128-134, 1983. 19 126. Johnson JS and Kilburn KH: Cadmium induced metal fever results of inhalation challenge in a solderer. Am J Ind Med 4:533-540, 1983. 127. Lesser M, Chang JC, Orlowski J, Kilburn KH and Orlowski M: Cathepsin B and propyl endopeptidase activity in rat peritoneal and alveolar macrophages. Stimulation of peritoneal macrophages by saline lavage. J Lab Clin Med 101:327-334, 1983. r 128. Kilburn KH, Warshaw RH, Boylen CT, Balmes JR, Johnson S, Seidman B and DeFlorio G: Toxic effects of formaldehyde and solvents in histology technicians: a preliminary report. J Histotechnol 6(2):73-76, 1983. C 129, Kilburn KH: Editorial: Byssinosis, emphysema and mortality of American textile workers. Arch Environ Health 38(5):277, 1983. 130. Warshaw RH, Brooker A, DeFlorio G, Einstein H and Kilburn KH: A micro-computer based system for the screening of r occupational health groups. Computers in Critical Care and Pulmonary Medicine, Volume 3, Plenum Press, 1983. 131. Kilburn KH: Lung disease: Lessons from the past-keys to the future. Arch Environ Health 39:139-143, 1984. i. C 132. Kilburn KH: Genetic aspects of chronic bronchitis. In: Chronic Obstructive Bronchopathies. Ed. by P. Freour and W.W. Holland, London: Kimpton Medical Publications, 1984. 133. Kilburn KH: Particles causing lung disease. Monograph on Pulmonary toxicology. Environ Health Pers 55:97-110, 1984. C 134. Kilburn KH: Treatment of industrial chronic bronchitis. In: Current Therapy of Respiratory Disease. Reuben M. Cherniack, editor, B.C. Decker, Inc., pp. 120-123, 1984. 135. Kilburn KH: Byssinosis: Causes and practical control. Ann C' Internal Med 101:252-254, 1984. 136. Kilburn KH: Respiratory functional impairment in welders in interpretation of current data. CEC and WHO Symposium. Copenhagen, February 18-22, 1985. Excerta Medical International Congress. Elsevier, 1985. C 137. Kilburn KH, Warshaw RH and Boylen CT: Airway obstruction, volume loss and respiratory symptoms in Los Angeles shipyard welders. CEC and WHO Symposium. Copenhagen, February 18-22, 1985. Excerta Medical International Congress. Elsevier, 1985. 20 138. Kilburn KH, Lilis R, Anderson HA, Boylen CT, Einstein HE, Johnson SJS and Warshaw RH: Asbestos disease in family contacts of shipyard workers. Am J Pub Health 75:615-617, 1985. 139. Kilburn KH, Warshaw RH and Thronton JC: Signs of asbestosis and pulmonary function in women who worked in shipyards. Am J Ind Med 8:545-552, 1985. 140. Kilburn KH, Warshaw RH and Thornton JC: Asbestosis, pulmonary symptoms and functional impairment in shipyard workers. Chest 88:254-259, 1985. 141. Kilburn KH and Warshaw RH: Pulmonary function testing for occupational epidemiology and disability. In: Pulmonary Function Testing Indications and Interpretations. A. Wilson, Ed., San Diego, Grune and Stratton Inc., pp. 329-337, 1985. 142. Kilburn KH, Seidman B and Warshaw RH: Neurobehavioiral effects of formaldehyde and xylene exposure in histology technicians. Arch Environ Health 40:229-233, 1985. 143. Kilburn KH, Warshaw RH and Thornton JC: Pulmonary functional impairment and symptoms in women in the Los Angeles harbor area. Am J Med 79:23-28, 1985. 144. Kilburn KH, Warshaw RH, Boylen CT, Johnson S, Seidman B, Sinclair R and Takaro T Jr: Pulmonary and neurobehavioral effects of formaldehyde exposure. Arch Environ Health 40:254-260, 1985. 145. Kilburn KH, Warshaw RH, Einstein K and Bernstein J: Airway disease in nonsmoking asbestos workers. Arch Environ Health 40:293-295, 1985. 146. Kilburn KH: Human values and social responsibility: a response to Mr. Ward. Am J Indust Med 9:25-27, 1986. 147. Kilburn KH and Warshaw RH: Respiratory functional impairment in metal welders: an interpretation of longitudinal and cross-shift studies of welding gases and fumes. In: Proceedings, of .Industrial Health Foundation Chromium Symposium. 1986: An Up Date. Arlington, VA, May 20-21, 1986. 148. Kilburn KH, Warshaw RH and Thornton JC: Asbestosis and pulmonary disease in shipyard workers and their families. Arch Int Med 146:2213-2220, 1986. 149. Kilburn KH, Lilis R, Anderson HA, Miller A and Selikoff IJ: Interaction of asbestosis, age and cigarette smoking in producing radiographic evidence of diffuse interstitial fibrosis. Am J Med 80:377-381, 1986. 21 150. Kilburn KH: Medical screening for lung cancer: perspective and strategy. J Occ Med 28:714-718, 1986. 151. Kilburn KH, Warshaw RH and Thornton JC: Formaldehyde impairs memory, equilibrium and dexterity in histology technicians: effects which persist for days after exposure. Arch Environ Health 42:117-120, 1987. 152. Kilburn KH: Role of chemical exposure on permanent lung injury: acute and chronic. In: Mechanisms of Cell Injury: implications for Human Health. B.A. Fowler, Ed., John Wiley and Sons Limited. Dr. S. Bernhard, Dahlem Konferenzen, pp. 281-290, 1987. 153. Kilburn KH, Warshaw RH, Thornton JC and Husmark I: An examination of factors that could affect choice reaction time in histology technicians. Am J Indust Med 15:679-686, 1989. 154. Miller JA, Cohen GS, Warshaw RH, Thornton JC and Kilburn KH: Choice (CRT) and simple reaction times (SRT) compared in laboratory technicians: factors unfluencing reaction times and a predictive model. Am J Indust Med 15:687-697, 1989. 155. Kilburn KH and Warshaw RH: Pulmonary functional impairment from years of arc welding. Am J Med 87:62-69, 1989. 156. Kilburn KH, Warshaw RH and Thornton JC: Pulmonary function in histology technicians compared to women from Michigan: effects of chronic low-dose formaldehyde on a national sample of women. Brit J Indust Med 46:468-472, 1989. 157. Kilburn KH, Warshaw RH, Boylen CT and Thornton JC: Respiratory symptoms and functional impairment from acute (cross-shift) exposure to welding gases and fumes. Am J Med Sci 298:314-319, 1989. 158. Kilburn KH, Warshaw RH and Shields MG: Possible improvement in neurobehavioral function following detoxification of firemen exposed to polychlorinated biphenyls (PCBs). Arch Environ Health 1989; 44:345-350. 159. Kilburn KH: Is the human nervrous system most sensitive to chemical toxins? Editorial, Arch Environ Health 44:343-344, 1989. 160. Kilburn KH, Warshaw RH, Boylen CT, Thornton JC, Hopfer SM, sunderman FW and Finklea J: Cross shift and chronic effects of stainless steel welding including chromium and nickel concentrations in body fluids. Amer J Indust Med 16:607-615,1989. 161. Kilburn KH and Warshaw RH: Does expiratory flow limitation indicate airways obstruction due to asbestosis in construction workers. East Texas Medicine. 2:27-31, 1990. 22 162. Kilburn KH and Warshaw RH: Abnormal pulmonary function associated with diaphagmatic pleural plaques due to asbestos. Brit J Indust Med 47:611-614, 1990. 163. Kilburn KH and Warshaw RH: Pulmonary functional impairment associated with pleural asbestos disease circumscribed and diffuse thickening. CHEST 98:965-972, 1990. 164. Kilburn KH and Warshaw RH: Effects of individually motivated smoking cessation in male blue collar workers. Am J Public Health 80:1334-1337, 1990. 165. Kilburn KH and Warshaw RH: Airway obstruction in asbestosexposed shipyard workers: with and without irregular opacities. Respiratory Medicine 84:449-455, 1990. 166. Kilburn KH: A case for ending use of asbestos. Forum for Applied Research and Public Policy 5:87-89, 1990. 167. Kilburn KH and Warshaw RH: Abnormal lung function associa ted with asbestos disease of the pleura, the lung and both: a comparative analysis. Thorax 46:33-38, 1991. 168. Kilburn KH: Asbestos and other fibers. In: Maxcv-Rosenau Public Health and Preventive Medicine. 13th Ed JM Last ed. Appleton Century Crofts, 1991. IN PRESS 1. Kilburn KH and Warshaw RH: Asbestos disease in construction, refinery and shipyard workers. Ann New York Acad Sci in press 1991 2. Kilburn KH and Warshaw RH: Difficulties in attribution of effect in workers exposed to asbestos and rotary spun fiberglass. Am J Indust Med in press 1991 3. Kilburn KH and Warshaw RH: Absence of restrictive disease in advanced asbestosis: How airways obstruction reduces vital capacity. Thorax in press 1991 4. Kilburn KH: Profound neurobehavioral deficits in an oil field worker exposed to hydrogen sulfide. Am J Med in press 1991 5. Kilburn KH: Pulmonary and neurological effects of aluminum. In environmental and occupational medicine. W Rom ed. 1991 23 6. Kilburn KH: Byssinosis and other diseases among textile workers. In Environmental Occupational Medicine W Rom ed. 1991 7. Kilburn KH: Evidence that the human nervous system is most sensitive to environmental toxins. Environ Carcinog Rev in press 1991 8. Kilburn KH, Warshaw RH and Hanscom B: Are hearing loss and balance dysfunction linked in construction iron workers? Br J Indus Med / SUBMITTED 1. . Kilburn KH, Warshaw RH, Thornton JC, Jenkins DE, Hsu KHK and Hsi BP: Effects of Los Angeles residence on children's pulmonary functions. AJPH 2. Kilburn KH, Warshaw RH and Thornton JC: Expiratory flows decreased in Los Angeles children from 1984 to 1987: Is this evidence for effects of air pollution? AJPH 3. Kilburn KH and Warshaw RH: Effects of asbestos exposure with and without irregular opacities on airways obstruction, lung volume and air trapping in never and current cigarette smokers. chest 4. Kilburn KH, Warshaw RH and Thornton JC: Pulmonary function in Los Angeles women across 4 years: a prospective study of smog exposure. Arch Internal Med 5. Kilburn KH and Warshaw RH: Measurement of body balance (sway) for evaluating effects of neurotoxins. Neurotoxicol Teratol 6. Warshaw RH, Hanscom B and Kilburn KH: Field experience with the blink reflext stimulated by glabellar tap in occupational groups. Neurotoxicol Teratol 7. Kilburn KH and Warshaw RH: Effects of increasing profusion of opacities due to asbestosis on airways obstruction, lung volume and air trapping. Chest in press 1991 8. Kilburn KH and Warshaw RH: What predicts reduced diffusing capacity for carbon monoxide (DLCOgfc) in asbestosis? J Appl Physiology 9. Kilburn KH and Warshaw RH: Pulmonary effects of exposure to fine fiberglass. Lancet 10. Kilburn KH and Warshaw RH: Occupational asthma and airways dysfunction in aluminum workers compared to regional and national controls. Am Rev Resp Dis 24 \ t\\s //f 11. Kilburn KH and Warshaw RH: Absence of restrictive disease in advanced asbestosis; How airways obstruction reduces vital capacity. Thorax 12. Kilburn KH and Warshaw RH: Comparison of methods for measuring lung volumes in advanced asbestosis: helium rebreathing underestimates TLC and RV. Chest 13. Kilburn KH and Warshaw RH: Severity of pulmonary asbestosis as classified by ILO profusion of irregular opacities in 8,749 asbestos exposed American workers: Never smokers compared to ever smoked. JAMA 14. Kilburn KH, Powers D and Warshaw RH: Pulmonary effects of exposure to fine fiberglass irregular opacities and small r airway obstruction. Am J Med 15. Kilburn KH and Warshaw RH: Irregular opacities in the Lung, Occupational asthma and airways dysfunction in aluminum workers. Thorax 16. Kilburn KH and Warshaw RH: Total lung capacity in asbestosis: a comparison of radiographic and body piethysmorgraphic methods. Chest 17. Kilburn KH and Warshaw RH: Neurobehavioral impairment downwind from a petroleum refinery with a desulfurization C unit: Low dose hydrogen sulfide exposure. AJM 18. Kilburn KH and Warshaw RH, Thornton JC, Thornton K and Miller A: Predictive equations for total lung capacity and residual volume: From radiographs based on a probability sample of the Michigan population. Thorax 19. Kilburn KH, Miller A and Warshaw RH: Measuring lung volumes in advanced asbestosis: Comparability of plethysmographic and radiographic versus helium rebreathing and single breath methods. Am Rev of Resp Dis 20. Kilburn KH, Warshaw RH and Thornton JC: Emphysema in men exposed to asbestos: physiological correlations with radiographic criteria. Chest 21. Kilburn KH and Warshaw RH: Prospective study of neurobehavioral effects of formaldhyde and solvents on histology technicians. Environ Res 25 IN PREPARATION 1. Kilburn KH, Chusid E and O'Dell B: Effects of copper deficiency on the static compliance and alveolar size of rat lungs during growth. 2. Kilburn KH and Chusid E: Effects of growth and starvation on static lung compliance and alveolar size in rats. 3. Kilburn KH and Moro A: Zinc and copper reversal of Bis (Dichloroacetyl) diamine (WIN 18,446) induced congenital defects in rats. 4. Kilburn KH, Kilburn J, Moro A and Husmark I: Reproductive and maternal effects of inhaled formaldehyde in rats. 5. Kilburn KH, Warshaw RH and Thornton JC: Alveolar carbon monoxide levels in second and fifth grade Los Angeles school children: relation to cigarette smoking prevalence, side stream smoke exposure and air pollution. 6. Kilburn KH, Warshaw RH and Thornton JC: Prevalences of asthma, chronic bronchitis and of reactive airways in second and fifth grade school children in Los Angeles. 7. Kilburn KH, Warshaw RH and Shields MG: Neurobehavioral effects of polychlorinated biphenyls (PCBs) and their byproducts on firemen. 8. Kilburn KH and RH Warshaw: Chronic neurobehavioral effects of environmental exposure to chemicals from residence near a waste oil reprocessing facility. 9. Warshaw RH, Hanscom B and Kilburn KH: Blink reflex stimulated by glabellar tap in normal subjects and exposed occupationally or environmentally to hydrogen sulfide. 26 .0'TAbLe 1: NEUROBEHAVIORAL TESTS, FUNCTIONS MEASURED AND THEIR SOURCES TEST FUNCTION ASSESSED SOURCE DATE Choice Reaction Time Eye-hand coordination motor speed Kilburn 198? Balance Proprioceptive, vestibular, cerebellar and visual control Warshaw 1988 Story 1 & 2 Verbal memory Wechsler memory scale 1945 Pictures Visual memory Wechsler memory scale 1945 Digits Forward and Backward Verbal memory Wechsler memory scale 1945 Block Design Visual-spatial skills Slotted Pegboard Trails A Eye-hand coordination, psycho motor speed Wechsler 1971 adult intellegence scale-revised Purdue 1963 Trails B Mental flexibility attention, eye-hand' coordination HalsteadReitan battery Finger Writing Peripheral sensation, cerebral interpretation HalsteadReitan battery 1958 1966 Embedded Figures Cognition - sorting Valciukas competing messages from background 1966 Culture Fair Nonverbal intelligence, design recognition, reasoning Cattell 1951 Profile of Mood States Emotional status, self appraisal McNair 1971 REF. 11,16 17 18 18 18 19 20,21 20,22 20,22 23 12,13 14 , 15 < \ TABLE 2 LLOYD SMITH (LS) COMPARED TO NEUROBEHAVIORAL TEST SCORES AND CONFIDENCE INTERVALS (sd) FOR 14 CONTROL FIREMEN WITH SIGNIFICANT DIFFERENCES 95% Confidence 14 Controls interval limits m sd lower upper LS Age Years as fireman Education Level Story 1 verbal memory Story 2 verbal memory Visual memory 34.9 + 8.5 * 14.1 + 7.7 11.2 13.6 + 2.8 9.6 + 4. 1 11.7 + 2.9 30.5 - 37.2 12.7 - 15.0 8.0,- 10.9 10.8 - 12.8 41 0 12 10 + .8 10 + Digits forward Digits backward 6.9 +i 1.4 5.1 + 1.2 6.5 - 7.6 4.5 - 5.4 7 5 Block design score 31.9 + 6.0 30.5-33.5 29 + Pegboard dominant Pegboard non-dominant errors 70.4 + 6.6 67.1 - 73.0 93 + 78 + 0 Trails A Trails B 1 errors 27.8 6.5 66.4 + 17.3 0.2 24.3 - 29.6 58.6 - 71.3 36 + 90 + 0 Finger DerceDtion error writing rt. error writing 1ft. 1.7 + 1.5 2.3 + 1.9 0.9 - 2.3 1.1 - 1.6 * 8+ 2 Embedded Figures 31.4 + 5.0 29.5 - 33.2 33 Culture Fair 63.4 + 6.3 60.8 - 65.8 58 + Reaction times Simple 1 2 3 Choice 1 2 3 , 574 -" 543 - 604 . 290 290 315 680 + 1035 ' 615 BALANCE eyes open 1 2 eyes closed 1 2 1.30 + 1.55 + .33 .86 1.16 - 1.43 1.13 - 1.70 1.40 1.54 1.45 1.32 Digit Symbol Information ^Similarities ^^icture completion 19 22 16 14 - 26 17 - 27 14.5 - 17.5 46 25 26 15 LLOYD SMITH (LS) COMPARED CONFIDENCE INTERVALS (sd) DIFFERENCES TO NEUR08EHAVIORAL TEST SCORES AND FOR 14 CONTROL FIREMEN WITH SIGNIFICANT 14 Controls m sd 95% Confidence interval limits lower upper LS '' POMS 1 Tension POMS 2 Anger POMS 3 Depression POMS 4 Vigor POMS 5 Fatigue POMS 6 Confusion Total POMS score 11.2 + 7.2 9.5 + 8.1 8.7 + 9.4 19.1 + 3.1 5.9 + 3.3 6.4 f 3.3 22.6 7.8 5.1 4.7 16.2 5.74.7 - 13.9 12.8 12.1 19.6 10.3 8.9 - 9 8 7 12 1 4 17 + Significantly impaired f nl y