Document X7Mgy2bE48vVxeymY2we7XYwK

FILE NAME: Shell (SHEL) DATE: 1979 May 31 DOC#: SHEL019 DOCUMENT DESCRIPTION: Shell Management Report with Cover Memo from 1965 Nov 22 RE Health Hazards from Asbestos 4M-32 (*.9-571 SHELL OIL COMPAN . KEFEtENCE irculate - Initial PRIVATE & CONFIDENTIAL t w Z l 1 REFINERY MANAGERS , ANACORTES DATE NOVEMBER 22, 1965 m o m MANAGER - MANUFAC .ENGINEERING DEPAB HEAD OFFICE Ml XL-FOM-- ^ -- ___ -m l r - HOUSTON MARTINEZ NORCO WILMINGTON WOOD RIVER o b e s s a /c i n i z a SUBJECT HEALTH h a z a r d s FROM ASBESTOS r 1 9 (5 _ P _AGS- 4 H JV- There has been considerable discussion in medical circles in recent years concerning the possibility of harmful effects to insulators from long-term _ file e x p o s u r e to asbestos. This matter has been a recent subject of an investigation ,/*1Gy the API Central Committee on Medicine and Health. Attached is a report vhich summarizes the current status of the study vhich vas presented at the mid-year API meeting of the Central Committee. It includes a summary of the findings from a recent survey of workers in the petroleum industry to determine if there vere any potential problems from exposure to asbestos. ' We thought you should be informed concerning this matter since vork in progress by the U.S. Public Health Service and the medical profession is apt to focus increased attention on the health of vorkmen engaged in insulation activities. You vill note from the conclusions in "the attached report that the data obtained to date is considered inadequate to resolve the question as to the degree of hazard posed to refinery insulators. For this reason, ve see no cause for alarm at this time. However, you may wish to review the potential exposure to insulators from asbestos dust to determine if there are any situations where some additional precautions appear desirable. Subsequent to review of this report by the Committee on Industrial Hygiene of the Central Committee on Medicine and Health it was decided that, although the data so far accumulated was insufficient to draw any conclusions, a task force should be established to continue the review and make recommendations for future action. We will keep you advised if anything significant develops. ABS-003995 management report Prepared for: SHELL OIL COMPANY One Shell Plaia Houston, Texas 77001 lr. cooperation with: Charles E. Ross, D.O. Medical Director Occupational Health Surveillance Corporate Medical Department Hay 31, 1979 By: David P. Discher, M.D. Chairman, Department of Industrial and Environmental Medicine Sar. Jose Medical Clinic 65 South Seventeenth Street San Jose, Ca ABS-051072 r ( ' ; t Section 1 BACKGROUND Prior to 1963, insulators at Wood River were exposed to asbestoscontaining materials although the crude estimates of exposure indicate that environmental levels were relatively lov in relation to the present OSKA standards. Since 1963, Shell employees working at new construction projects have beer, exposed only to nonasbestos insulation materials, however, especially since 1970, the ripping out or stripping down of old units with insulation has continued to be a potential source of low-level asbestos exposure. A training program put into fcrce in 1970 required chat all Shell employees exposed to asbestos at Wood River learn wettingdown techniques prior to rip-out, and that they know how to bag and burv the material, as well as how to use a respirator. In July 1972, the Shell corporate medical director issued a memo relative to the medical requirements of the OSHA asbestos standard. In December 1973, revisions were communicated by the corporate medrca* director; moreover, shortly thereafter, the General lianager Refining Head Office issued a memo to all refinery managers informing them of the need to identify significant pas: exposures so as to assist in determin ing additional Snell employees who should be plate: or. medical surveillance. In reviewing .asbestos examinations in November of 1978, Dr. B. J. Kern, Shell Medical Director-- Northern Region, noted several relevant items regarding the annual examination of current and former _ asbestos workers: , C 1 > ABS-051073  A questionnaire (described in a 1972 **o free the corporate edlcal director) is completed and signed by the asbestos . vorktr" in the medical department after a plant nurse checks the box narked `'annual'' and records the employee's name, number, date, work location, age, height, weight, and sex. Forced expiratory spirometry and a chest x-ray is obtained at a local hospital (at St. Joseph Hospital from 1973 to 1975 and at Alton Memorial Hospital from 1976 to 1978). A copy of a spirometry report, dated and signed by the technician, and a copy of the radiologist's interpretation are both mailed to the medical department at Wood River. A plant nurse transfers information from reports received in the mail, placing the data in the middle portion of a form entitled, ''Special Medical Examination (Asbestos).'' Dr. Michael F. Mitchell, plant physician, examines the patient, evaluates the reported information (as veil as his ovn examina tion findings in relation to evidence of lung disease, limita tions for respirator use, or the need for further clinical studies), and signs and dates the form. Dr. R e m did not visit either hospital, nor did he discuss the procedures in detail with the plant physician or nurses. He did retrieve sect medical data or. smoking history, spirometry results, and chest x-rav interpretations from 197- to 197E. On November 15, 1978 , he submitted a memo to the corporate medical director. lr. this memo he reported his analysis of 41 vorkers who had asbestos examinations and compared the findings or. these 41 employees with 41 other employees, selected randomly. The key findings noted by Dr. Kern vere that a large fraction of workers had abnormal spirometry tests and the chest x-rayinterpretations appeared to be inconsistent with previous readings. At that time Dr. R e m was unable to determine whether these findings represented a genuine health problem or vere merely a procedural problem. During Dr. R e m 's analysis. Dr. C. E. Ross, Shell Medical Director, Occupational Health Surveillance, was completing a data processing task that 'involved abstracting certain data from all special medical examinations. The Wood River spirometry data in Dr. Ross's analysis differed in some respects from the spirometry data of Dr. Kern, especially in that the listing of Dr. Ross included tests obtained in January 1973, and the listing included 47 asbestos vorkers at Wood River. 2 ABS-051074 On January 24, 1979, Dr. Roa* issued a memorandum to Mr. R- L. Brunner, Manufacturing Safety and Health Manager, outlining plans for spirooetry testing and quality assurance requirements for spirometry. In his nemo, Dr. Ross Bade the following points: There are many ways to calculate predicted normals. Macv different types and models of equipment are available for the test. Different levels of sophistication are required to use the equipDent properly and to do the test properly. Requirenents for a permanent record differ from case to case. Proper calibration of the equipnent is required. A certified training prograr is needed for persons doing the ' test, whether they are Shell nurses or contractors. A computer program is needed to track the performance of such persons and to detect significant changes in function in individual asbestos workers (as veil as groups or subgroups) at various locations. Dr. Ross then referred to the Kerr, report ar.d noted certain steps to be taken bv this consultant at Wood River. 3 ABS-051075 Section 2 CONSULTANT'S EVALUATION The f o l l o w i n g background i n f o r m a t i o n on Bpiroaetry is pertinent ^q observations at Wood River end the three local hospitals* Tr,e spironetry test for asbestos workers is intended primarily to detect restrictive dysfunctions (low forced vital capacity or FVC) associated with clinically significant lung fibrosis or scarring. Tne E t a te-of-the-art for spirometry testing to detect this scarring has progressed in recent years such that three complementary techniques will vield the maximum for case detection at a minimum cost of false positives. The highlights for each cf these techniques *re presented below. FVC, when measured as the best trial or largest value ("E77; corrected" , or adjusted to standardize for climate and ali.tude) is generally reported as a percent of predicted value. Persons vnth clinically significant fibrosis usually have values below 701 of predicted for their age, sex, height, and race. Kamy persons may be mildly symptomatic and have objective evidence of asbestosis with FVC values between 701 and 80... However, a single FVC value below 801 of predicted is not diagnostic of asbestosis, ncr is a value of greater than BO* an absolute assurance that the Individual is free of asbestosis. A second approach to the early detection of restrictive dvsfunctior. is to measure accumulated .or annual decrements in FVC. If a nonsnoker asbestos worker were to experience a decrement from year 1 to year 2 greater than 0.07 t and thus decrement were to occur each year and accumulate for 5 years, ther the accumulated decrement would be 0.35 t. (Note: The FVC could still be well above 801 of predicted, but a 0.35-1 decrement would be about three times that expected for a nonsmoker. This ~ 0.35-1 decrement would be well beyond any combi nation of biological variation and reasonable calibration error.) Ve recotmend the use of an 81 decrease in FVC as a single-year "flag" indicating an excessive loss in volume of vital capacity (not an average decrement over several years). However, A ABS-051076 for ccx=ulji_tjcd'decrements over 3 or more years, ve recomeod that * decrement in excess of *2 per year be flagged ss indicating restrictive dysfunction irrespective of the calculated percent of predicted values. Thus, if the physician or clinician uses decremental dysfunction as an aid in the early detection of asbestosis, the accuracy of spirometry testing can be increased. A third approach to early detection of dysfunction is the epidemiologic detection method, vherein one examines grouped data by smoking category and exposure level. In this method, if a group of workers shows a greater FVC loss than expected, one can suspect an excessive exposure to asbestos. By means of a computer program now under development in the Shell corporate medical offices, occurrences of such losses in FVC will be flagced and local plant physicians notified. The algorithm for this technique is to be embodied in the biostatistics package. Thus, three ways are available to identify significant ventilatory restriction: (1) an individual has an FVC level less than 80* (7C. for persons without any other findings) of predicted FVC; (2) a decrement of 41 per year occurs over several years (or an 82 decrement occurs in any single year), and (3) mean FVC values decrease more than expected, depending on the sire and characterislics of the risk group. Pers-- s described in items (1) or (2) would generally be flagged for specie, clinical review ar.d subsequent annual reviews; persons in item (3) would be flagged for special studies if the entire group shoved gradual, but excessive, losses ir. FVC values. Since spirometry measurements also include obstructive indicators such as an. 802 of predicted forced expiratory volume in the first second of effort (FEY^ or an FEV^ q /FVC rat^ ^ess than 0.7G the sane sort of analysis can be m.3de for obstructive diseases of non occupational origin so as to provide some specificity to the surve_i-- lance. For persons having "mixed flags" (both a flag for FVC and either of the obstructive cutoff flags), the first action should be no different than -for a restrictive dysfunction problem. Vhen the only flag is obstructive, the action should be directed to smoke cessation, if applicable, and/or a referral for pulmonary workup for other non occupation causes. 5 ABS-05107 The technique for performing forced expiratory apirometry is not easily learned from a syllabus but requires practical inatruction and practice with a wide variety of workers, all of whoa have their Individual activations, language problems, educational level, etc. Our experience indicates some technicians never learn this technique, even after several hours of lecture and 8 hours of small group instruction. Appendix 1, a 1978 report of an ad hoc conaittee, includes their minimum criteria for a training course and lists the course objectives. This committee, recently reconstituted into a nev Council on Occupational Respiratory Disease (CORD) has developed a course certification program, as veil as other guidelines for developing ORDS. This committee also prepared the syllabus material in Appendix 2. These documents will be further developed by CORD, and NIOSH will be publishing a revised version of this syllabus shortly. A 100-page bookie: providing s broader perspective of ORDS is being considered by CORD for publication. 6 ABS-051078 r C ( Section 3 PRELIMINARY STUDIES OF DATA RETRIEVED BY DR. RERN As indicated above, Dr. K e m audited the medical records of 41 asbestos workers and a randon sample of 41 nonasbestos workers at Wood River , who had spirometry tests as a part of the voluntary periodic examination program. For each asbestos worker. Dr. K e m made a data sheet, with a column for each year and a note on the right side investing the worker's age in 1978 and his or her smoking history (years and packs per day). In each column he listed the laboratory-reported measured FYC and FEY (liters to the nearest tenth), predicteds, percent of 1. C predicteds, ratio of the FEY^ ^ to FVC, and a brief summary of the chest x-ray report. Kv analysis of this data differed somewhat from Dr. Kern; however, ve reached similar conclusions. 1 noted that among the asbestos workers, 29 of 41 vere below 801 of predicted FYC at one or tore of the arx-cspirenstry tests. I doubted that the predicted values were accurate (perhaps the values vere from different equations, retrieved erroneously, or recorded incorrectly at the laboratory). In cy tabulation of the results from 41 nonasbestos workers, 31 of the 41 had FVC values less that, so: of predicted. 1 found about the same fraction of current cr former smokers among the two groups (21/31 in nonasbestos workers and 21/25 in asbestos workers). In scanning the FVC and F E V ^ measured data on the asbestos verkers, 1 ncted that most of the low FVC values (compared with predicteds or compared with previous years' measured FVCs) had occurred in the past 2 years. I also noted that in the first year in which the new machine was used at Alton Memorial Hospital (1976), many asbsetos workers who had been tested 2 years previously at St. Joseph Hospital had significant increases in F/C. This increase indicated that the tests at Alton max ABS-051079 hive been Inaccurate in one direction in 1976 because of a problem in cilibritioo equipment and in another direction in 197v and 1978 because of premature terminations (or aubnaximal efforts) due to poor technician performance. To test this hypothesis, 1 identified 21 of the 41 asbestos workers vho had spirometry data all 5 years. The 5-year grand mean for FVC was 3.74 t, and for FEV, 2.96 l. The expected age decrement for FVC would be about 0.20 and 0.35 i, respec tively, for the 5-year period (this estimate would depend greatly oc the level of cigarette smoking for the 21 persons, plus the "aging effect" on an active working population of males at average age of 50.7 1 9.7 years). Thus, one would expect the asbestos workers, if no asbestcsis were occurring, to show 1974-initial FVC values of abcut 3.84 l ani 1S78 values of 3.64 I-- the difference of 0.20 1 being due to aging and seeking. This population shoved a remarkably higher average decrenent of 0.91 1 (froc 3.90 to 2.99 1). The FEV 0 decrenent froc 3.06 to 2.65 l (cr 0.43 I) is not unexpected. These results are consistent with the hypothesis that 1976 FVC values are artifacts due to .premature.terninations of effort. Also Included in my analysis of these 21 asbestos workers was a comparison of mean FEV and mean FVC values. This comparison was * i w performed to identify any trends for each year of spirometry testis.;. For FEY^ Q the first 3 years are all similar, but the next 2 years appear to show a remarkable decrement. The only additional observation o_ FEV q is the remarkable increase in standard deviation for 1976, suggesting some difficulty with the electronics of the spirometer during the first fev weeks of its use at Alton Memorial Hospital. Tne more impressive results are evident in the FVC mean values for 5 ytars: the highest value was in 1976 and the standard deviations for 1976 a..* 1977 are both much higher than usually observed in a tale workforce. Again, the suspicion of equipment problems in 1976 is evident fro_ scanning across the 5 years of FVC values for each person, noting kov frequently the value for that year appears to be an outlier. 8 ABS-051080 In >w.T~y, I reviewed a recent audit of Dr. B. J. JCern. In general, Dr. Kern and I agreed that othin{ was peculiar In the spirometry data. In the 1976 data I found an Increase in spirometry variance, associated vith numerous high outliers and high mean values, all of vhich suggest equipment and calibration errors. I also noted low FVC values in 1977 and 1978, vhich strongly suggests poor technician performance becauae of premature terminations. The principal question at the tine of my visit to Wood River on February 8, 1979, vas'vhether Dr. Kitcbell was aware of the above audit problems, whether his lack of any clinical diagnoses of restrictive lung disease reflected this lack of confidence, and whether we could confirm that the spirometry data collected a: Alton Memorial were as deficient as they appeared. The general thrust of the above analysis was reviewed vith Dr. Ross on February 7, 1979, and plans were made for meetings and data collection the next d2 y at the Wood River refinery. 9 ABS-051081 Section A OBSERVATIONS OF SPIROMETRY TESTING AT THE THREE HOSPITALS On February 8, 1979, Dr. Ross and I Bet vith the company representa tives most reponsible for plant safety and health: Messrs. Porter Slack, Jin Gibson, Perry Rawlins, and Dr. Mitchell. After brief introductions I asked Dr. Mitchell to review the Occupational Respiratory Disease Surveillance (ORDS) program and his assessment of it. Dr. Mitchell stated his deep concern about the validity of the spirometry data obtained at Alton Memorial, and also suggested that he might have core confidence In spirometry as a tool if Dr. Mohyuddin, ar. internist specializing in pulmonary diseases at St. Joseph anc St. Anthony hospitals, were to help direct the pulmonary laboratory technician providing these data.. Be reported discussions vith the Alton technician, J. Dingersor., suggesting that she had difficulty in obtaining good patient cooperation in the time available. Ve discussed several other background issues, and then proceeded to Alton Memorial, St. Anthony, and S:. Joseph hospitals where I asked each technician to perform spirometry tests on me. At Alton Memorial, after the results of my first trial were recorded, I was instructed by the technician, J. Dingerson, that nc further trial was necessary since mv results were well above 301 cf predicted for both FEV, and FVC. The predicted* came from a sliderule estimate, not from tables provided by corporate medical offices. 1 purposely gave a submaxinal effort on this trial, ar.c asked her if she notec! anything on the test. She only repeated that the results were g o o d based on the 501 rule-of-thumb provided to her by an anesthesiologist who is her advisor. 1 asked her about mechanical calibration and a graphic record and found she was unfamiliar with the need for either. Since: I knew: the reported FEV^ ^ and FVC values were low, I asked if I could do the test again; when my second trial results were more than 221 better, I asked for her comment. She reported that she did not feel 10 ABS-05108 that another trial vould be necessary, not understanding the fact that reproducibility i* the hallmark of maximal effort. Since my true FYC value (BITS corrected) i 71 lower than that reported by Ms. Dingerson, based upon y second trial at Alton Memorial, I judged the equipment to be cut of calibration and that it was consequently over-estimating true volumes considerably. Since the FEV^ Q reading on the spirometer vas 162 too high, the equipment may have had a 1-second trigger delay. At St. Anthony and St. Joseph hospitals, the technicians had better equipment, knew how to do a reasonably good test, and recognized my subr.axinal effort on the first trials. At neither hospital was the equipment calibrated by approved techniques, however. In summary, we visited three hospitals and found the required instrument calibration procedures were not in force at any of the pulmonary laboratories. The equipment that ve were tested upon a; St. Anthony and St. Joseph hospitals vas almost identical except for the fact that the spirometer at St. Joseph had been inactivated am; may have had a drag on the timing gears that would be repairable. The equipment at Alton Memorial Hospital was grossly inadequate and appeared to be 72 out of volume calibration and probably had an additions. dtlay in the 1-second trigger. No graphic record was provided from tests at Alton, whereas the records at the other two hospitals vere avaiUc.e fcr me cc check on equipment and technician. The technician performance at Sc. Anthony and St. Joseph hospitals was excellent but could be improved. The technician performance at Alton Memorial was grossly inadequate. 11 ABS-051083 Section 5 ricommikdations Proposed Spirometry Standards and Related Support for ORDS The Wood River ORDS program should be integrated into a corporatevide tsedical program, which would include the following points: For spirometry testing of asbestos workers, the techniciansnurses performing the test must be certified, which would ^ establish that they had a basic, practical under standing o: the quality testing and calibrating requirements. Tne equipment must also be certified and maintained in calibration. The test results must be reviewed for reliability and inter pretation, using locally understood endpoints, plus a corporate technician and computer system to rechecV. calculations and inferences. -- - - - The local plant physicians must learn to interpret test re^.lts and know what followup studies are indicated. Tne medical supervisors of these physicians must pro\idc guidance and support for the program, both in the field as veal as in the corporate facility. Kcnmedical employees and managers must have a vritter. plan for developing these needs and maintaining the ORDS program. Certification of scirooetry testinc personnel: Ve recommend a corporate-wide training course be held in Houston under the CO*D certification program. Prior to this course, certain infomatior. should be gathered from all locations having an asbestos ORDS program. V'nere appropriate, the plant physicians should be included in a portion cf the 2-3 -'day program. A Shell syllabus should be circulated prior to the first training program, and a pretest examination might also be useful. J urge thuz ns Bjironetry testing under the Shell ORDS be aor.e un bu noncerzifiei persons. 12 ABS-051084 Qz y 1 1flct1on of equipment *nd implementation--of--a-- ^ ^ -- ---program: The first step in equipment calibration would be to adopt minimum equipment requirements consistent with the ATS and ACC? standards for forced expiratory spirometry. One way would be to purchase a small calibration packet with instructions and mail the packet from one place to another for local use. Another way would be to detail this packet together with a technician or nurse who vould'check'the calibration and also check the examination, techniques, calculations from graphs, and the interpretation of .data. 1 recocmend that equipment requirements and calibration procedures be prepared and signed by the corporate medical director prior to the training course. I urge tnai t e e . m g ir. i. crA t h e r e a f t e r be perform,ed o n ly on c e r t i f i e d ecuip-.ert that has a current caiteration. Corporate interface and software support: The Ross systen most be expanded to handle the broader list of raw data indicated in the previous section, as well as to provide algorithms to verify loca. _ reliability checks and rating flags. Tne role of corporate and regional offices would need to be defined with respect to feedback of the data base .to the users at the local level in a manner that promotes morale. j r e z z -- ens m uel~.-dzcur.ented ebrtguter program. be prepzrea cc.z tna: the co rp ora te s o f r a a r c package end do current at io n be in r e n t e r use f o r detz obtained in I960 a r j t h e r e a ft e r . Phvslclan diagnostic criteria and referral assistance: Integration of the various portions of ORDS program is essential, not only regarding clinical criteria but also for the local chest consultants who may be. called to assist when needed. I reccrr.erA t h a t data be gatherea fra-, e l l Sh ell plant physician.s regarding the diagnostic crite ria that trey are u sin a , as v e i l as the lo c a l chest co n su lta n ts they are using. These data should be analyzed by corporate medical s t a f f e d disseminated back to the local physictans. ABS-051085 13 Management support: As a followup to the memorandum of January *, 1974, 1 believe a communication from corporate to local managers vould be helpful if it vould focus on spirometry testing and its importance in asbestos ORDS. The memo should outline some of the above plans and accompli shments. Data Obtained in Wood River Retrospective-- 1978 data and all prior data: Based upon my analysis to date, 1 have much less confidence in the 1976-78 spirometry data than in the 1974 and 1975 data. I am unsure as to hov data vas collected in 1973, but my presumption is that it is equivalent in quality to that obtained in 197A and 1975. To be sure about the data in 1973-75, 1 recommend that samples of the graphs for these years be copied and reviewed. With respect to the 1976-76 examinations, I urge that all spirometry data be declared invalid. Specifically, the medical charts should be so noted and all computer-processed data should be asterisked, indicating it as unreliable. Communications to workers, managers, and local community physicians should be planned, as appropriate, based upon further studies of the data and recommendations herein. Prospective-- 1979 data and henceforth: Two long-term alternatives vould be to internalize spirometry testing or to obtain such data by contract from one of the three hospitals visited in Alton. Dr. Mitchell and plant management at Wood River should select either of the tvp laboratories other than Alton Memorial and proceed to obtain 1979 spirometry testing after the selected laboratory technician telephones me for instructions. 1 believe it more important to solidify the rawdata'aspect and to defer temporarily the central software package. This vould mean an early corporate decision on a training program and whether or not internalizing is possible at Wood River. If the nursing staff is stable and reasonably facile, I vould suggest that equipment be purchased and that training be planned for having spirometry done at 1* AES-051086 the plant dispensary by plant nurses who would be certified thli June. J recommend t h a t no t e s t i n g i n 1980 be done under erg c o n tr a c t arrange ment v i t h o u t having a s a t i s f a c t o r y equipment package (in c lu d in g frequent calibrations) and a f u l l y trained technician, both equivalent to c e r t i f i c a t i o n (ATS and COED, r e s p e c t i v e l y ) . After spirometry testing problems have been resolved and standards agreed upon, the data should be fovarded to Dr. Kitchell for his prompt analysis and appropriate action. Dr. Mitchell has suggested that be have a designated chest physician for backup; this suggestion seems sound and should be explored further. Corporate offices need to be advised as to all actions taken by these physicians. . 15 ABS-051087 Section 6 SUGGESTIONS FOR FURTEER WORK Analysis of All PROS Data on Ten Selected Persons Prior to ny visit to the Wood River refinery and to the three hospitals in Alton, I examined data prepared by Drs. Kern and Ross. I concluded that both the spirometry and the x-ray results were suspect. During my visit, I was only able to assess spirometry equipment and technique, confirming that these data vere very likely unreliable for the pest 3 years of ORDS. To confirm that the previous spirometry data vere satisfactory would require my examining, on a sample basis, the 1973 to 1975 spirograms, if available. The second aspect, that of chest film results, adds two new questions: Are the films generally of adequate quality? Dc the generally negative interpretations stand up under qualified review? Before leaving the refinery. I left the names of 10 employees and indicated that as a supplement, 1 would be requesting all raw and derived data on these persons (copies of graphs of spirograms from St. Joseph Hospital. 14 x 17 inch chest x-rays from the two hospitals, and copies of the entire medical records in the refinery medical department). A report on my findings would be submitted vithir. 45 day, of my receiving these records. 1 selected these persons because of the questionable findings reported-thus, they are not a random sample, but a selection of problem cases. The names and basic data are as follows: 16 ABS-051088 Employee 1 J 1 4 5 6 7 8 7 10 1973 1974 + + X- ray 1975 1976 + + + 4 1977 4 1978 + Dates Spirometry Performed 1973-1978 1973-1978 - 1974-1978 * - - 1973-1978 - - - - - 1973-1978 . + + + 4 - 1973-1978 + + _ _ 1973-1978 . + + + 4 4 1973-1978 4 1973-1978 ... 1973-1978 Spirometry Results OK Obstructive? Restrictive? Obstructive? Kixed? Restrictive OK Restrictive? Obstructive? Restrictive? Restrictive? Obstructive? Restrictive? Obstructive? Restrictive? Obstructive 4 * clinically significant finding. - no clinically significan t finding. * s t a t u s uncertain. Assistance on ORDS at Other Locations, as Needed The basic thrust of this preliminary report.responds to Shell ORDS development at all locations. As 1 complete the supplemental phase above, I can see benefits in my briefly visiting other locations and helping corporate medical staff in planning a course for all nursing personnel, as well as some plant physicians. As a first step, I have prepared for your office a suggested communication to the various Shell plant physicians. This memo begins with a statement of the general problem of spirometer and technician quality control. An attachment to this is a questionnaire which would give Shell Corporate Hedical staff ABS-051089 17 certain basic information from each plant location. A follovup concur,ication Bight deal with guidelines and standards that you vi.h then to follow and the forms to use. Backup for the Asbestos Surveillance Examinations at Wood Ri.yer_ln_l.97i Assuming that these examinations are completed by July 1, 1 would be able to evaluate the spirograms, chest x-rays, and medical examina tion forms by approximately August 1, 1979. In addition to evaluating the quality of each person's examination, I would make a brief general report on the overall performance of 1979 studies. 1 would anticipate that this would require approximately 20-25 hours of my time. IB ABS-051090