Document OzEGVkgqg6N257gL88yXOeXjK

FILE NAME: Saranac 7th Symposium (SSY) DATE: 1952 DOC#: SSY039 DOCUMENT DESCRIPTION: Transcript of Presentation by Mr. Hill with Discussion TAKEN FROM PAGE 682 i I I i j i* i t Ia 3 `.i' ' ' " ' 7 7 j I 3 id Gsatlc^'ai It's m bassr m d a V'T** *?- :*>. Ir;a tr:tafal for tba oppsHnity ___ ,633*4 to participate in this symposium. I 'm tremendously impress-! j ed with the amazing job that is being done here and I only ! wish that all compensation adninistrators could have this experience, as I am sure that it would be as inspiring to them as it has been to me* A a originally enacted, none of the workmen's j compensation lava specifically provided benefits for dis- , ability or death resulting from occupational disease* How j ever, the Massachusetts Act, passed in 1911? covered per sonal injur.- "3 without the qualification th-fc they be *`ol den tal, but it was not until 191 ` that it was determined that silicosis ue.a coyered by the law* It is now generally recognized tnat citaoillcy or death from occupational diseases should be eom.pvasated* General coverage for all occupational diseases .1.3 provided j j in ,?lj. states, Alaska, District of Columbia, Euwali ^nd under the Federal Employees Compensation Act and tna jjOiigohOi'om^n j and Harbor Workers * Act* Shceaulo coverage is prov,iu3d in | 20 states and Puerto Rico* Ji It is quite obvious that tne all-inclusive typs j i! og coverage provides the better protection and cno onlj j i Just covorago. There is not ons good reason to give coupon^ sation benefits to one man suffering Ci-cn-i an occupational | disea. 3 and to deny them to another simply because tne latter is suffering from a disease not known when the schedule v ..3 made* j: The provisions regarding payment for disability j !; i j! or death rid medical care in the case of occupational disease j| are usually tho same as for other injurias, except for pul- j| raonary dust diseases which are subject to limitations, not j I placed on benefits for other injuries* J j A man disabled by a pulmonary dust disease 13 as : j i' much a casualty of industry as a man who suffers from a rup-j I tured disc or a broken leg, but he does not, except in a | few jurisdictions, get t;,a same treatment* ! Now, I was not hare on Monday morning, so I dida'fcj p P have the benefit of th definitions, but as Iunderstand i: ! the! j | term 'pneumoconiosis' It means dust storage and includes all conditions of the lung3 that result from the inhalation of i duet, that from simple drat storage and those from tho sfeor- j age of various irritntir .. dusts, the most common of which is ; silica* j I understand that silica is the most harmful dust j 1i1 t, to which workers are exposed in industry, and that silicoaisj ji I i!i is the most common of the dust diseases found In industry* j ij As a compensation administrator, my experience has been lis-; itea to the evaluation of silicosis cusos, so I s' il direct: | rcy remarks in the main to some of tho pro1-loins we cat in tiia handling of silicosis claims* Of course, it's comparatively simple when the II __________ ____ __ ____ _____________________ 685.J j ii employer or carrier is satisfied that the worker has a dis abling sl3'cosis. In those cases, the benefits provided by the act are automatically paid* However, that may not be an] auequate disposition of the case. Many workers suffering j from silicosis are as much in need of rehabilitation as the j worker suffering from the effects of a traumatic injury* | ; A foundry worker suffering from silicosis and unable to work] at his skilled trade, but able to work,, should be given the cpportxm ij and the means for rehabilitation* Our serious problems arise in tbs contested cases, whore the employer and carrier, if the risk is insured, con- trends that th e worker docs r >t have silicosis and denyos j that he is disabled because of silicosis. Administratively,) It was a comparatively simple task, under the original part of the occupational disease part of the act, to dotormina whethe~r a worker had silicosis* It provicod for tus ap-pona;i\ jssat of a commission of three qualified, Impartial pnyaieiftn ! to examine the worker when It was disputed that ha was aul- j faring from an occupational disease* j It riso pi ,vidod that the report, when signed by | two members, was final and conclusive on tne question of whether or r-.-t the claimant was suffering from the disease claimed* Sc, in every disputed silicosis case, tho claim ant was cl! ! for such on Impur vial paysIcal e camana tion* If the report stated that he did not have si. sis, nis claim was summarily dismissed. If it was reported that the worker had silicosis, a hearing - 3 necessary to determine I whether he was disabled. That procadui>e worked satisfac torily. It provided a scienti. c method for the determina tion of medical facts and relieved us of that burden. It wc.3 used for Over eight years, until our Supreme Court de cided the provision was unconstitutional because it violated tha due process clause, as the opportunity for cross-examin-j at-ion of the physicians who made the medical finding, was . not giv-im* | Kow, na make the medical fact-finding from msdtcalj testimony submitted by the parties. The testimony is gen erally conflicting, rarely can it be reconciled end at best,j it is puz sling and very difficult to evaluate* As I under- j J stand it, there are throe rather standard factors which must! bo considered in d3 cid3.ng whether a man has silicosis. i First, oecupptional hiato. /j second, en&raeverlstic X-ray j findings ; third, charao teristic clinical sym.pL.cms* Ct inarily, it* 3 not difficult to docleo whether a worker coul habo had sufficient exposure to siij.ee. dust urine tha cc irso of his employment to cause Sxiicc s. tpv-a i'sal problem Logins when wo attarepb to evaluate tne A-- ray findings, feme physicians insist that a worker can not have si lleosis unless his X-rays --new discreet or congxom- erate nodular fibrosis. They s^,. that silicosis can nos be 687. diagnosed without'-such X-ray evidence. They refuse to consider reticulation or increased , linear markings, regardless of occupational history and clinical ayrapt-oraa, as diagnostic of silicosis. However, mjmjr will admit that a microscopic examination of the lung tissues might reveal evidence of silic Other physicians insist that increased linear narfcj- ings when considered with history of exposure, and clinical , symptoms, can be diagnostic. They call the condition early j silicosis. Can silicosis bo diagnosed from occupational j history, chest X-rays showing reticulation and cheractori3tie symptoms, or must the X-raya show discreet nodular fibrosis Sj Is there ouch an entity as a clinical dust disease e d bjj storage of silica dust, that can be diagnosed as a dust dis-j case, though not labeled silioosia because it can not oe ' reco^itod as silicosis from the X-ray* Which of the three factors, occupational history, X-ray findings, symptoms, is the ioost Important in deciding whether the worker has silicosis or a pulmonary dust disease due to duet storage* Is there a correlation between the extent of %...o empn^cema and the extent of the lung involvement? Does extensive ea-| pLysema indicate more silicosis "ban can be recognised by j x ,,r ,/? Gan emphysema be due to silica storage without X - r a y evidence of discreet nodulation? : )OE3 pahyvsici&ns say the emphysema is seconds r'V to 688, the aging process and not to silica storage whan the X-ray film Tails to disclose nodular fibrosis* They maintain there must bo -odul&r fibrosis in ordar to have sufficient lung involvement to cause emphysema. Othor physicians take a contrary view and state that where the X-rays shew increased linear- markings, together with emphysema, tn&t tnej emphysema is cu-sed by the lung involvomont due to silica j storage* | la it pos-Mbls to determine which riftdie al tneory j is accurate? 5Tno anawors to these questions, if they can j be specifically answorod, would be invaluable to the compen sation adainistratev-s who are not fortunate enough c-o on impartial medical hoard to wake the medical detormina- ticr, It seems quite obvious that the most satisfactory rs suit can be obtained by having the nodical deteminatlan o f whether the claimant has silicosis or any clinictl. dust d t ^ ease conclusively decided by a qualified impartial m ^ ieal b o a rd * A l&rgo percentage of our silicosis clnimj bn Michigan arise because the unemployed foundry uoul^.r or ainar is unaole to get a Job. It is *Ho policy in seme foundries to discharge a worker when M s chest X-ray shows *n abnormal condition. That policy is not used by a single mini.ng company. -Tnn-,e^ ,workerr. ia i1In1vVadrjiJaSbbliy'/ refused em`ployment vhen he apdies for work at another foundry. i 6 8 9 ..]___ Generally, he he.. had several years exparie. ee in | a skilled occupation and knows no other trade. He is will- j ing and able to continue working at his trade, but nis trail ing, experience an. ability to work are of no value to him j when ho can not get a job. Having failed to get a job, he j employs an attorney and a silicosis claim is filed. It's j not unusual for the physician who recommended his discharge j to testify that the in: does not have silicosis, because | the disease can not be recognised from cheat X-rays* | j Tine claimant's physician will probably testify j hat the X-rays show first degree silicosis or both may t c H tify that the X-rays show increased linear markings, but one says no silicosis and the other calls it early silicosis* j I uakes no difference to the nan whether it's j discreet nodular fibrosis or increased Hue*, markings* j He doesn't care what the physician ca. Is nis condition, 'j.no ; important fact, to him, is feat he can not got a job at his j trade, ih may not be physically disabled, but he has a def-; inite disability, because his potential earning capacity has no value to him v.aen he is not employable. His loss of am- | payability must be considered in determining his right to ; compensation. Physical inability to do tbs Job can not. be ! the sole test* We have a similar situation whan a foundry lays o.f men in a slack period or ceases operations, or a minin'* _620 corapany closes one of Its rainss. The foundry worker with abnormal chest findings simply can not get a job, and some times the foim ry does not recall him for work though the raining companies, invariably provide surface jobs for the man who have silicosis and should not work underground. They will not hire another company's workers when they have abnormal chest findings. These men became compensation claimant3 because they are not able to secure employment at their respective trades. What can be done to prevent this loss of employ ability of workers with abnormal cheat findings? How can tiro needed productivity of these men be utilised? It j.3 certainly mroalistic to put those skilled workers on the shelf and pay them compensation which is unproductive and, at best, a very poor substitute for a regular pay chock, most of thorn would r tefer to continue at tnalr trad, V,Te arc in a vicious cycle, because of tire employora* employment standards. Cl course, if you want to blame | someone, you can readily blame the compensation adminis tra- j tor. Wera public servants and it's rather popular to make i us a whipping post. However, I think that any fail* analys-*.^ of the problem will indicate that the loss of employability which precipitates a large percentage of the silicosis exaims is due either to the employers' lack of understanding or | his refusal to attempt to solve a problem wiicn is peculiarly 691* within his powar to solve. The industrial physician is not entirely blameless, because the employer often acta on his advice. The burdens j are not gol g to be relieved until employers use vary sciorr tific measure known to remove the dust h --.ar-ds and provide j safe working conditions as many have already done, and tnan make any and ufery possible effort to utilize the skills of every available worker even though ' 3 may have soma cnest abnormality whoa such condition dees not inter -.era with hit performance of work# Only than will we have a paucity of silicosis claims and the cost bought in human misery and compensation for silicosis will level off to a very minteum. Several of the compensation laws provide that no compensation is payable for partial disability from silico sis. It would be almost impossible to evaluate percentage- wise a nun's loss of pnysical ability due to silicosis. A silicotic is either employable in h* : regular trade or m another occupation whore there is no exposure to silica or I not employable. LTa should bo compensated when lie cun not L5 work at his regular trade or is ur 1e to secure work bacau ^ of iiis silicosis. He should be c pensated for his'age loss Wudn ho is employed in a n o n -injurious occupation at a ; lower wage. He should be paid compensation in the amoi...t of the difference between his weekly v:aga in nis skilled trade and that in the non-inJurlous occupation, but not to exceed the maximum ay&ble for total disability* i Should the compensation laws contain a pr -vision | that to be compensable, disability from silicosis must occurj within a specified period after the last exposure or after the last day of work for the employer from wnora compensation,; is claim-' ? I sa; absolutely not, but several states have j such a limitation in their compensation ' aw, varying in time from 120 days to too years. Should a man become dis abled from silicosis 2 iuonths after ne has, for ona resswn , or another, loft the employment in which he was last oaposod to silica dust? If so, he would not have a remedy in many ) of our states in which silicosis is supposed to be eompon- 3 able. His right to compensation woulu toe fcavrod because of the lapse of time sines exposure or employment. There is no good reason for denying compensation merely toeca .use the worker *s disability do d not occur within a specified period of t !me after -xposure whan the c -tse of ) tiie disability is established. Hare in How York, tus verier or in case of death, his dependents, can go and file a claim within ninety days after disablement and after knowledge ! th.at tiia disease is or w as duo t o tssisiployraont o time limitation in Michigan is thanotice of the di hi: nent must be given to the employer within 120 days > r the date of disablement, which has been construed our 693.. court to be within 120 days after the worker has knowledge or reasonable ground for knowledge of his disablement. In at least five other states, any limitation against the claim does not .tart to run until the worker to -j comes disabled from silicosis. There is absolutely no xsas4 on for raking it more difficult to get benefits for silicosis than for a traumatic Injury, when the disease is due to the nature of the employment. Workmen*a compensation benefits for silicosis has created severe! problems, none of which can be sclysd by en assortment of limitations which are manifestly unfair tO| the worker. I believe that the old adage, an ounce of 1*3-j vent ion is worth a pound of cure, is a proper - is apropos | in this fie!-, Most of the problem -an be solved by pro- j vontlva insures designed to eliminate or minimize the sil-j ica hazard and by realistic sensible employment standards, j She duration of the problems will depend directly noon w e j willingness or unwillingness of employers to adopt ! r.n.ir3S and am n lo y r/o o t s t s n a f t r d s . Thank t o 1' fin-1 BY you very much. Jlm That vas well stared. very effective stat jnt of your point of view, Ar-ny cl the issues, I happa a to disagree with you upon, but that's ny privilege and the similar privilege of those in tn-,, audience 1r' i Cur next speaker, William L. Connolly, is a Director of the Eureau of Labor Standards of the United States Department of Labor. He was called to that post aftsj? having served for six years as Director of Labor of the 1 State of Rhode Island where he supervised the administration of the workmen's c mpens&tion laws of that state# To M s honor and credit, he is a former president of the Rhode Island State Federation of Labor, seme years past, he has served with distinction, ana I v -'eracore that word distinction, as chairman ,-f the Cc 'Grain*king Oor-mittae of the President's Conference on Indus trial Safety* I s :S8 l a vrs Bill Connolly probably knows more about the prob* | I IncId3at to administration of workmen's compeasatiox ' i th an any of in this room. Over and boyend that, he j 13 a g ra n d p e l's on 1-rT1 1 So di r e e t l y th i a dir... BY V*q ,-s n r io n . NC['LT: (Mr. Connolly read a prepared pa.yor wh* -h is on j file at the Sarar.ac Laboratory). j BY }1R . WAT-r. i ; ' j Thank you, Bill, that was boautifully d o n s , i Cur* next participant is s. well known to tills xud* lance that I wl11 make but brief comment in his introduction. His friendship with the Saranac Labor-, -ary, for industry, u. S. DEPARTMENT OF LABOR &UR3AU 0? STANDARDS WASHINGTON September 3, 1952 Dr. Arthur J. Vcrvnld, Director Tlie T rudeau F oundation and The Saranac laboratory 1 P. 0. Box 551 Sai'citsac Lake* Dew lor* Dear Dr. Vorwld* i*ufc vou for sending a copy of the minted P:.orr>~ for the Seventh Saranac Symposium. The scnedul* L co.nrdetely In line with ny understenu tn& wivh J-ir. haters. A. cop? of 3 oUteoont t ti. c ^ J <* s t! pn=* * i --'"i -> % ? ? * * , S S , vh % reouest. Another cony has beer nmfc to -- vara, the questions which I ao Buggsu -j.ng. 1 Since e v particlnation in the Syranosin - is strictly i in line of duty," my ejroenees will P8^ oofc cur 1,16 s ao:,,i*opriatlon. iDOirth. I era looking forward to being with you later this Very truly yours, WIU.IAK L. CCHNCIXY Director