Document ZB0OG8gL1GEM0D7peV8JJvd7

LESTER AND SHERRICE BARRETT VS. MOBIL OIL CORPORATION, ET AL. DEPOSITION OF ETHAN A. NATELSON, M.D., F.A.C.P N0. B-150, 698 IN THE DISTRICT COURT JEFFERSON COUNTY, TEXAS 60TH JUDICIAL DISTRICT On October 22, 1997, the oral deposition of ETHAN A. NATELSON, M.D., F.A.C.P., was taken at the instance of the Plaintiff in the offices of St. Joseph Medical Center, 1315 Calhoun Street, 18th Floor, Houston, Texas, pursuant to Stipulation attached hereto. 2 1 Those persons present were as follows: 2 MR. J. KEITH HYDE and MR. JAMES E. WIMBERLEY 3 Provost * Umphrey Law Firm, L.L.P. 490 Park Street 4 P. 0. Box 4905 Beaumont, Texas 77704 5 Counsel for Plaintiffs, 6 LESTER and SHERRICE BARRETT 7 MR. RICHARD 0. FAULK 8 Gardere, Wynne, Sewell & Riggs, L.L.P. 333 Clay Street, Suite 800 9 Houston, Texas 77002-4086 10 Counsel for Defendants, 11 MOBIL OIL CORPORATION, ET AL. 12 MS. DIANNA L. EDWARDS, CSR Charlotte Smith Reporting, Inc. 13 235 Orleans Street 14 Beaumont, Texas 77701 15 16 17 18 19 20 21 22 23 24 25 3 1INDEX 2 DEPOSITION OF ETHAN A. NATELSON, M.D., F.A.C.P. 3 October 22, 1997 4 5 PAGE 6 EXAMINATION BY MR. HYDE 7 - 141 7 EXAMINATION BY MR. FAULK 141 - 143 8 RE-EXAMINATION BY MR. HYDE 143 - 146 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 4 1EXHIBITSINDEX 2 DEPOSITION OF ETHAN A. NATELSON, M.D., F.A.C.P. 3 October 22, 1997 4 5 EXHIBIT NO. DESCRIPTION PAGE 6 1 Three-page document entitled, "Plaintiff's Third Amended Notice 7 of Oral/Video Deposition, with cover letter 8 8 2 Three-page letter report to Mr. 9 Richard 0. Faulk from Ethan A. Natelson, M.D., F.A.C.P., dated 10 July 10, 1997 11 11 3 Copy of Pages 511 and 512 of "A Textbook of Medicine" edited by 12 Russell L. Cecil, M.D., Sc.D. and Robert F. Loeb, Sc.D., D. 13 Hon. Causa. 33 14 4 Copy of Pages 731, 738, 739, and 740 of "Principles of 15 Internal Medicine" with T. R. Harrison being Editor-in-Chief 33 16 5 Pages 394, 395, and 396 of 17 "Clinical Hematology" by Maxwell M. Wintrobe, M.D., Ph.D. 48 18 6 Eleven-page article entitled, 19 "Notice of Intended Changes Benzene" 57 20 7 Copy of the "Federal Register," 21 dated Friday, September 11, 1987, "Part II, Department of Labor, 22 Occupational Safety and Health Administration, 29 CFR Part 1910, 23 Occupational Exposure to Benzene, Final Rule" 59 24 25 5 1 8 Fourteen-page document entitled, "Proportional Mortality Ration 2 (PMR) Analysis of Crown Zellerbach Death Certificates, 1981 - 1985," 3 dated June 2, 1987 60 4 9 Seven-page document entitled, "Benzene and the Dose-Related 5 Incidence of Hematologic Neoplasms in China" 62 6 10 Thirty-six-page document entitled, 7 "Revised (7/14/97), An Updated Mortality Study of Workers at a 8 Petroleum Refinery in Beaumont, Texas" 71 9 11 One-page letter to Dr. Ethan 10 Natelson from Richard 0. Faulk, dated June 30, 1997 82 11 12 One-page letter to Dr. Ethan 12 Natelson from Betty Bourbon, Legal Assistant, dated July 09, 13 1997 83 14 13 Documents entitled, "Volume I and II of Direct Interrogatories 15 to: Custodian of Medical Records for St. David's Health Care 16 System, Austin, TX, Pertaining to Charles Lester Barrett" 84 17 14 Document titled, "Direct 18 Interrogatories to: Custodian of Medical Records for Dr. Enrique 19 Spindel, Austin, TX, Pertaining to Charles Lester Barrett" 112 20 15 Document titled, "Direct 21 Interrogatories to: Custodian of Medical Records for Dr. Enrique 22 Spindel, Austin, TX, Pertaining to Charles Lester Barrett" 112 23 16 One-page chart done by Mr. Hyde 24 during deposition 115 25 6 1 17 Copies of articles from the medical literature that generally 2 deal with gastric lymphoma and lymphomas of what we call the 3 MALT category, Helicobacter pylori and the association 4 between Helicobacter pylori-and lymphomas, non-Hodgkin's 5 lymphoma in general and classifications of that illness, 6 and the relationship between Helicobacter pylori and gastric 7 cancer. 129 8 18 One-page letter to James Wimberley from Enrique Spindel, M.D., dated 9 11 July 1997 139 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 7 1 ETHAN A. NATELSON, M.D., F.A.C.P., 2 having been duly sworn, testified as follows, to-wit: 3 EXAMINATION BY MR. HYDE: 4 Q. Good afternoon. Would you please introduce 5 yourself? 6 A. My name is Ethan Natelson. 7 Q. Dr. Natelson, what is your home address? 8 A. 8707 Wateka, W-a-t-e-k-a, Drive, Houston, Texas 9 77074. 10 Q. And what's your telephone number? 11 A. Well, the work number here is area code 12 713-652-3161. 13 Q. And how are you employed? 14 A. Well, in several ways. I -- I have several 15 jobs. I'm the director of medical education at St. 16 Joseph Hospital. And in that category I'm paid by the 17 hospital -- those type things. I'm also in private 18 practice, and I do that here at this Stehlin Oncology 19 Clinic. And then I gain money from seeing private 20 patients. 21 Q. Dr. Natelson, my name is Keith Hyde. And we 22 have never met, correct? 23 A. That's correct. 24 Q. Do you understand that you are under oath to 25 tell the truth today? 8 1 A. Yes. 2 Q. If at any time I ask you a question that you 3 don't understand, will you tell me that so that I can 4 rephrase my question? 5 A. Yes. 6 Q. And, Doctor, if at any time you'd like to take 7 a break, we'll take a break for whatever reason. Is 8 that agreeable to you? 9 A. Excellent. 10 MR. HYDE: Would you mark that, 11 please? 12 (AT THIS TIME NATELSON EXHIBIT N0. 1 13 WAS MARKED FOR IDENTIFICATION PURPOSES AND 14 IS FULLY DESCRIBED IN THE "EXHIBIT INDEX" 15 HEREIN. SAME WILL BE FOUND AT THE 16 CONCLUSION OF THIS DEPOSITION.) 17 (By Mr. Hyde) 18 Q. Doctor, I've had attached as Exhibit 1 the 19 notice of deposition for your deposition today. 20 Obviously, you received a-copy of that document. 21 A. Yes. 22 Q. We requested that you bring with you certain 23 items, including a current resume or a curriculum vitae. 24 Do you have such a document? 25 A. Yes. 9 1 Q. And that's in this pile in front of me? 2 A. Yes 3 Q. We requested that you bring a copy of your 4 complete file in this matter. Is what's in front of me 5 now everything in your file? 6 A. Well, what's in front of you are all the 7 materials that Mr. Faulk has sent me and any letters or 8 bills I might have sent him and then certain medical 9 papers from my files. 10 Q. Is there any information in your file 11 concerning this lawsuit that is not in front of me that 12 is still in some other file? 13 A. Well, the answer would have to be yes in the 14 sense that this lawsuit deals with lymphoma. And I have 15 hundreds of papers that deal with lymphoma, books, 16 texts, and many other things that I might either 17 consciously or unconsciously rely on when asked 18 questions that have to do with lymphoma. So what I 19 brought are articles that I think are most pertinent and 20 would support the views that I would give. 21 Q. So as we sit here today, the documents that you 22 have here in front of you concerning non-Hodgkin's 23 lymphoma, those are the documents that you would expect 24 to give specific testimony on at the time of trial; is 25 that correct? 10 1 A. Well, I can't anticipate what questions you 2 might ask of me; and so these documents cover what I 3 think needs to be covered. There may be other documents 4 that I would need to supply depending upon what you 5 might choose to ask me. 6 Q. And it's your understanding that the documents 7 in front of you are the documents that you'll be relying 8 upon at the time of trial upon examination by Mr. Faulk; 9 is that correct? 10 A. Well, they may not exclusively be these because 11 medicine is a continuing operation. There may be an 12 article published next week that may have great 13 relevance, and I might use that if it turned out to be 14 pertinent. 15 Q. But as it concerns documents that are in 16 publication now that you have, the documents that are in 17 front of me are most likely the documents that you'll be 18 relying upon during your direct examination with Mr. 19 Faulk. Is that a fair statement? 20 A. Yes, sir. 21 Q. We also requested that you produce a copy of 22 any report prepared by you in this matter. Would you 23 identify that document, please? 24 A. Yes. That is this document (indicating). 25 MR. HYDE: Would you mark that, 11 1 please? 2 (AT THIS TIME NATELSON EXHIBIT NO. 2 3 WAS MARKED FOR IDENTIFICATION PURPOSES AND 4 IS FULLY DESCRIBED IN THE "EXHIBIT INDEX" 5 HEREIN. SAME WILL BE FOUND AT THE 6 CONCLUSION OF THIS DEPOSITION.) 7 (By Mr. Hyde) 8 Q. Doctor, would you please identify the document 9 which we've had marked as Exhibit 2? 10 A. This is a letter that I sent to Mr. Richard 11 Faulk on July 10th, 1997, concerning the case of Lester 12 Barrett versus Mobil Oil Company. 13 Q. When were you requested to write the document, 14 your report in this matter? 15 A. I can't tell you the exact date. 16 Q. Approximately when? 17 A. Well 18 MR. FAULK: I'm going to object 19 because 20 A. I don't really know. I can't -- Obviously 21 sometime before this. 22 MR. FAULK: Hold on a minute, Doctor. 23 I'm going to object because the question 24 lacks a foundation because it doesn't 25 establish that I, in fact, asked you to 12 1 prepare a report. You may answer the 2 question. 3 Q. Doctor, then I can clear that up. Who asked 4 you to prepare Exhibit 2, your report in this matter? 5 A. Mr. Faulk. 6 Q. And approximately when did Mr. Faulk or someone 7 at his firm request you to write Exhibit 2? And I'm 8 asking for an approximate time period. 9 A. I would say approximately weeks prior to this 10 letter -11 Q. Okay. 12 A. -- probably not months. 13 Q. Doctor, did you have a draft of Exhibit 2? 14 A. No. 15 Q. Did you have any document other than Exhibit 2 16 that you gave to any of the attorneys at Mr. Faulk's law 17 firm for them to review prior to July 10th, 1997 18 A. No, I -19 Q. -- that reflected your opinions in this matter? 20 A. No, I did not. 21 Q. So, therefore, it would be reasonable to 22 conclude that Exhibit 2, your report in this matter, is 23 the only document that you've written in this matter: 24 and there have been no drafts. Is that correct? 25 A. That is correct. 13 1 Q. We also requested that you produce a copy of 2 all documents reviewed by you in preparation for this 3 deposition. Are all those documents that you reviewed 4 in preparation for this deposition in front of me now? 5 A. Yes. 6 Q. Are there any others? 7 A. No. 8 Q. We requested that you produce all documents 9 that you have relied upon relative to the formation of 10 your opinions in this matter. And are those documents 11 in front of us today? 12 A. Well, again, as I said earlier, there -- there 13 are concepts that have to do with lymphoma that I have 14 many other documents that relate to that. And so 15 that -- I believe these documents will support my 16 opinion, but there may be others that I have that would 17 do the same. 18 Q. And, again, you have no specific intention of 19 bringing any of those other documents to trial as we sit 20 here today. 21 A. No, I do not. 22 Q. That was probably -- Since I phrased my 23 question in the negative and you answered in the 24 negative, it's -- I know what you and I meant to say; 25 but let me ask it this way, Doctor. Are there any other 14 1 documents except those documents that are in front of me 2 now that as we sit here today you intend to bring to 3 trial in this case? 4 A. No. 5 Q. Okay. 6 MR. HYDE: Off the record. 7 (AT THIS TIME THERE WAS AN 8 OFF-THE-RECORD DISCUSSION, AFTER WHICH THE 9 PROCEEDINGS RESUMED AS FOLLOWS:) 10 (By Mr. Hyde) 11 Q. Doctor, you've given your deposition before: is 12 that correct? 13 A. Yes. 14 Q. Approximately how many times, your best 15 estimate? 16 A. Perhaps 20 times. 17 Q. And you've given your case -- Strike that. 18 You've given your deposition in a case where the 19 plaintiff's name was Frias; is that correct? 20 A. Yes, that is correct. 21 Q. Did you review any of your past depositions in 22 preparation for today's deposition? 23 A. No. 24 Q. I understand that you typically are retained as 25 an expert witness approximately six to eight times per 15 1 year; is that correct -- involving six or eight cases? 2 A. That could be so. That would be approximately 3 right. 4 Q. And I understand that you have been testifying 5 as an expert witness at different rates obviously, not 6 rates in money but rates in how many cases per year, for 7 approximately 20 years; is that correct? 8 A. Well, it could be that long. I have testified 9 for -- and not necessarily in liability-type lawsuits, 10 but I've testified in a number of types of trials. And 11 it could date as long as 20 years. 12 Q. And it's fair to say that the great majority of 13 the cases in which you consult, you consult on behalf of 14 defendants, true? 15 A. The majority. 16 Q. Well, if you had to assign a percentage, 17 wouldn't it be correct that 90 to 95 percent of the 18 times in which you're retained as an expert in a case, 19 that you're retained by attorneys for the defendant? 20 A. I don't think it's anywhere near that high. 21 Q. Give me your best estimate then. 22 A. Well, my best estimate would be that about 23 If I review cases -- And you have to understand that if 24 I -- if I reviewed a case for the plaintiff and my 25 opinion might not be favorable to the plaintiff, then 16 1 there would be no deposition and no testimony on my 2 part. So I've reviewed a number of cases for the 3 plaintiff, but they have not come to trial or 4 deposition. And so if I look at the totality of cases I 5 look at, I'd guess it's probably about 70/30 in terms of 6 defendant and plaintiff. 7 Q. So that I'm clear on that, of cases that you 8 review, it's your best estimate that approximately 70 9 percent of those cases you are retained as an expert on 10 behalf of the defendant; is that correct? 11 A. That's correct. 12 Q. Now, in the cases in which you have given 13 deposition testimony 14 A. Right. 15 Q. -- would it be correct that that would 16 represent 90 to 95 percent of the depositions that 17 you've given that would be such that you'd be there on 18 behalf of the attorneys representing the defendant? 19 A. I still think that's too high. I can think of 20 several cases where I testified on behalf of the 21 plaintiffs, and I haven't done all that many cases. So 22 I don't know what -- the numbers, but 95 percent sounds 23 much too high. 24 Q. Well, do you have a better approximate? 25 A. I'd say probably in the range of 80 percent. 17 1 Q. So that the record's clear, for your 2 (AT THIS TIME THERE WAS IN 3 INTERRUPTION AT THE DOOR TO ANNOUNCE THAT 4 JIM WIMBERLEY WAS HERE, AND THERE WAS AN 5 OFF-THE-RECORD DISCUSSION.) 6 Q. In cases in which you've been retained as an 7 expert and you've given deposition testimony, your best 8- estimate is that approximately 80 percent of the time 9 that you give the deposition testimony, you're giving 10 deposition testimony on behalf of the defendant. Is 11 that a fair 12 A. I think that's fair, yes. 13 Q. Now, have you ever testified at the trial of 14 any lawsuit on behalf of a plaintiff? 15 A. Yes. 16 Q. And would that include a case involving an 17 allegation of chemical exposure causing a certain 18 hematologic disorder? 19 A. The answer would be no. 20 MR. HYDE: Off the record. 21 (AT THIS TIME THERE WAS AN 22 OFF-THE-RECORD DISCUSSION, AFTER WHICH THE 23 PROCEEDINGS RESUMED AS FOLLOWS:) 24 (By Mr. Hyde) 25 Q. Approximately how many times have you testified 18 1 at trial as an expert witness? 2 A. Possibly in the range of ten. 3 Q. And for those ten times that you've testified 4 at trial as an expert witness, those have been solely on 5 behalf of the defendants as it relates to hematological 6 disorders. Is that a fair statement? 7 MR. FAULK: Let me make an objection 8 because I think the question lacks a 9 foundation as to whether all of those ten 10 times were. 11 Q. Let me ask it this way. 12 MR. FAULK: Okay. 13 Q. Of the ten times that you've testified, how 14 many of those cases involved your giving testimony that 15 a plaintiff's hematological condition or disorder was 16 not caused by exposure to chemicals? 17 A. You'll have to run that one by again. 18 Q. Fair statement. 19 A. I got lost in that one. 20 Q. It's a complex question really for a simple 21 concept. Have you ever testified in trial on behalf of 22 a plaintiff that a blood disorder was caused as a result 23 of chemical exposure? 24 A. No, not to my knowledge. 25 Q. Have you ever testified that a plaintiff's 19 1 blood disorder was not the result of chemical exposure? 2 A. Yes. 3 Q. About how many times? 4 A. You're talking in trial? 5 Q. Yes, sir. 6 A. Two that I recall. 7 Q. Have you ever testified in a deposition that a 8 plaintiff's blood condition or blood-related cancer was 9 caused as a result of chemical exposure? 10 A. No. 11 Q. Do you know who Mr. Faulk is representing in 12 this lawsuit? 13 A. I believe Mobil Oil. 14 Q. Have you ever been to Jefferson County, 15 specifically Beaumont, Port Arthur, Port Neches? 16 A. Yes. 17 Q. What has caused you to go to Jefferson County? 18 A. Well, I purchased some citrus trees from a man 19 who lived in Port Neches once. I've been to Beaumont a 20 couple of times, I think to give some talks there. I 21 used to drive through that area commonly because my wife 22 lived in Louisiana. I can't recall the last time I've 23 been there. 24 Q. You said you gave some speeches in Beaumont. 25 To whom? 20 1 A. These would be medical talks. And it's been a 2 long time ago, so I -- I can't recall the details. 3 Q. Do you recall what hospital you were speaking 4 at? 5 A. Probably St. Elizabeth's, but I -- I don't 6 Q. Do you know that? 7 A. -- recall the details. I can't recall. It's 8 been a long time ago. 9 Q. How long ago? 10 A. More than ten years. 11 Q. Do you recall having any specific discussions 12 with any of the oncologists or hematologists in 13 Beaumont? 14 A. Not specifically. 15 Q. The speeches that you gave in Beaumont, do you 16 know what subject 17 A. They would be in hematology presumably. But, 18 again, it's been in hematology, which is my field. But 19 it's been so long ago that I -- I can't remember any 20 details. 21 Q. So as to the subject matter of any speeches you 22 gave in Beaumont, as we sit here today, you would be 23 guessing or speculating as to the subject? 24 A. That's correct. 25 Q. Specifically, have you ever been to the Mobil 21 1 refinery in Beaumont? 2 A. No. 3 Q. Have you been to the Mobil chemical plant, 4 specifically the 0 and A facility in Beaumont? 5 A. No. 6 Q. Have you ever had a conversation with any of 7 the Mobil plant physicians or plant doctors from either 8 the Mobil refinery or the Mobil chemical plant? 9 A. Not to my knowledge. 10 Q. I know that the Frias case in which Mr. Faulk 11 represented one of the defendants involved the Lyondell 12 Petrochemical and Atlantic Richfield. Do you recall 13 that? 14 A. I don't recall the companies that were 15 involved. 16 Q. And I understand that you have consulted with 17 Mr. Faulk while he was at Akin, Gump, correct? 18 A. Yes. 19 Q. Approximately how many times have you consulted 20 with Mr. Faulk or someone at Mr. Faulk's firm, 21 specifically Akin, Gump, when he was with that firm? 22 A. I have no idea. 23 Q. All right. Obviously, every case in which you 24 consulted with Mr. Faulk while he was at Akin, Gump 25 involved some type of hematological or blood disorder or 22 1 some type of cancer; is that correct? 2 A. Well, that would be correct. Yes. 3 Q. Now, when you say you have no idea, are you 4 talking because the number might be in the range of 20, 5 30, 40, or 50 times: or you just don't have a clue? 6 A. Well, the last one I remember was the Frias 7 case. Perhaps there was one before that. If there was, 8 I've forgotten about it. 9 Q. Okay. 10 A. But there certainly wouldn't be 20 or 30 cases. 11 Q. That's what I -- I just want to get an idea, 12 sir. 13 A. Okay. 14 Q. Mr. Faulk is now with Gardere Wynne Sewell & 15 Riggs. And besides this case, are you currently 16 testifying for Mr. Faulk as a consulting -- not as a 17 consulting but as a testifying expert? 18 A. Not to my knowledge. 19 Q. Approximately how many hours have you spent 20 working on this matter, Mr. Barrett's case? 21 A. Perhaps four or five hours. 22 Q. Does that include today's work? 23 A. We haven't concluded today's work yet, so I 24 don't know. 25 Q. Well -- 23 1 A. That would be up -- up until today, in other 2 words. 3 Q. And I take it that you had an opportunity to 4 meet with Mr. Faulk today, true? 5 A. Yes. 6 Q. And I would take it that you met with Mr. Faulk 7 for an hour or two? 8 A. No. That would be incorrect. 9 Q. About how long? 10 A. About 15 minutes. 11 Q. Dr. Natelson, what do you charge for your work 12 as a consultant? 13 A. Generally $200 an hour. 14 Q. And that's a flat rate whether you're in 15 deposition or whether you're reviewing documents or 16 whatever; is that correct? 17 A. Yes. 18 Q. And I take it that the money that you receive 19 from your consulting work goes directly to you: is that 20 correct? 21 A. Yes. 22 Q. Doctor, have you been supplied any exposure 23 information concerning Mr. Barrett and his exposure to 24 benzene? 25 A. No. 24 1 Q. Dr. Natelson, have you been provided with any 2 exposure information concerning Mr. Barrett's exposure 3 to butadiene? 4 A. No. 5 Q. Have you requested any exposure information 6 concerning Mr. Barrett and his exposure to any 7 chemicals? 8 A. No. 9 Q. What is your understanding of Mr. Barrett's 10 occupation while he was at the Mobil refinery and Mobil 11 chemical plant in Beaumont? 12 A. I think I commented on that in my letter, if I 13 can look at that. And what I could see from the medical 14 records, he had been employed as a pipe fitter for 15 15 years. And at the time of his diagnosis of lymphoma, he 16 was not in that line of work. 17 Q. What is your understanding as to what a pipe 18 fitter does in a refinery and chemical plant? 19 A. I don't know exactly what a pipe fitter does. 20 Q. To your knowledge have you ever observed a pipe 21 fitter performing pipe fitter work in a refinery or 22 chemical plant? 23 A. Definitely not. 24 Q. Doctor, have -- Let me strike that. Dr. 25 Natelson, have you been provided with any Mobil 25 1 documents concerning the health hazards of benzene? 2 A. No. 3 Q. Dr. Natelson, have you been provided with any 4 Mobil documents concerning the health hazards of 5 butadiene? 6 A. No. 7 Q. Dr. Natelson, have you been provided with any 8 Mobil documents specifically concerning toxicological 9 studies concerning benzene? 10 A. No. 11 Q. Have you been provided with any Mobil 12 toxicological studies or information concerning 13 butadiene? 14 A. No. 15 Q. Have you been provided with any Mobil 16 epidemiological studies? 17 A. No. 18 Q. Dr. Natelson, have you ever given any type of 19 public presentation concerning benzene? 20 A. Well, I've given talks on aplastic anemia; and 21 historically benzene has been a cause of that. So I can 22 say indirectly. I don't recall any specific lectures on 23 benzene in particular. 24 Q. Have you ever given a public presentation or 25 talk concerning butadiene? 26 1 A. No. 2 Q. Have you ever given a public presentation 3 concerning non-Hodgkin's lymphoma? 4 A. Many times. 5 Q. When is the last time you gave such a public 6 presentation concerning non-Hodgkin's lymphoma? 7 A. Well, we have a multidisciplinary cancer 8 meeting each Monday; and the public or anybody is 9 invited to that. There usually are about 50 people in 10 attendance. And we present cases of patients with 11 cancer diagnosed at St. Joseph Hospital. Commonly 12 lymphoma is a topic. And I probably presented within 13 the last two weeks at that meeting. 14 Q. Have you ever given a public presentation 15 concerning the cause of a specific case of non-Hodgkin's 16 lymphoma? 17 A. We've -- Yes, in the sense that we've talked at 18 this conference about MALT lymphomas, which are thought 19 to be induced by Helicobacter. 20 Q. And when did you first give that presentation? 21 A. We talked about that about -- either two or 22 three weeks ago. 23 Q. And that was after you had written your report 24 in this matter, correct? 25 A. Yes. It had to do with another patient of 27 1 mine. 2 Q. Doctor, are you aware that benzene is present 3 at the Mobil refinery in Beaumont? 4 A. I would assume it's there. I don't have 5 specific knowledge of what chemicals are located there. 6 Q. Do you know whether or not benzene is present 7 at the Mobil chemical 0 and A plant? 8 A. Again, I don't know what chemicals they have in 9 their repertoire. 10 Q. Do you know or have you been told what 11 percentage of the employees at the Mobil Oil refinery 12 are exposed to benzene? 13 A. No. 14 Q. Have you -- Do you know or have you been told 15 what percentage of workers are exposed to benzene at the 16 Mobil chemical 0 and A plant? 17 A. No. 18 Q. Do you know whether or not butadiene is present 19 at either the Mobil refinery or Mobil chemical plant, 20 specifically the 0 and A plant in Beaumont? 21 A. No. 22 Q. Have you ever visited an oil refinery, taken a 23 tour of a refinery? 24 A. No. 25 Q. Have you ever taken a tour of a chemical plant? 28 1 A. You have to define what you mean by chemical 2 plant. 3 Q. Fair enough, Doctor. In the Houston, Deer 4 Park, Pasadena, Channelview area, there are a number of 5 chemical plants that make a variety of chemicals through 6 the use of distillation towers and other process 7 equipment. And my question to you is: Have you been in 8 a chemical plant such as those that I've -- in the area 9 that I've just described? 10 A. No. 11 Q. And have you been in any refinery or chemical 12 plant in Jefferson County? 13 A. No. 14 Q. I want to start broad here, Doctor; and I'm 15 going to try to narrow it down. But hang with me here 16 for a second. 17 A. okay. 18 Q. When were you first contacted to be an expert 19 witness on behalf of Mobil? 20 A. In this particular case 21 Q. Yes, sir. 22 A. -- you're talking about? Well, it would 23 be -- It probably would be before the July 10th date. I 24 don't know exactly when. It would be perhaps a month or 25 two before that date. 29 1 Q. And you received some medical records: is that 2 correct? 3 A. Yes. 4 Q. And are those medical records in front of me 5 and Mr. Wimberley? 6 A. Yes. 7 Q. Do you know Dr. Spindel or Dr. Hoverman, the 8 physicians who treated Mr. Barrett? 9 A. No. 10 Q. Mr. Barrett has a cancer, correct? 11 A. Yes. 12 Q. And, more specifically, Mr. Barrett was 13 diagnosed with non-Hodgkin's lymphoma, correct? 14 A. Correct. 15 Q. And I suppose, more specifically, Mr. Barrett 16 has a form of non-Hodgkin's lymphoma known as gastric 17 lymphoma. 18 A. Yes. 19 Q. What specific cell type of non-Hodgkin's 20 lymphoma do you understand that Mr. Barrett has been 21 diagnosed with? 22 A. A B-cell large cell type. 23 Q. Do you have any quarrel or dispute about Mr. 24 Barrett's diagnosis, that being a B-cell large cell 25 non-Hodgkin's lymphoma, specifically gastric lymphoma? 30 1 A. No. 2 Q. Now, I think, and correct me if I'm wrong, that 3 there can be some other distinctions made when looking 4 at cell type. And I think they use the word diffuse or 5 other words, correct? 6 A. Correct. 7 Q. Did he have a diffuse large cell B-cell 8 non-Hodgkin's lymphoma? 9 A. Well, those terms are best applied to lymph 10 nodes: diffuse and nodular. In this biopsy he did have 11 nodular changes of lymphoid tissue, but the area of the 12 tumor was diffuse. But our classifications are 13 generally based on nodal lymphomas, not extranodal 14 lymphomas. This would be called an extranodal lymphoma. 15 Q. So with his extranodal lymphoma, he did have 16 characteristics of diffuse and -- What's the other? 17 A. Nodular. 18 Q. -- nodular. Dr. Natelson, have you published 19 any papers concerning benzene? 20 A. Not to my knowledge. 21 Q. Dr. Natelson, have you published any papers 22 concerning butadiene? 23 A. No. 24 Q. Have you published any papers concerning 25 non-Hodgkin's lymphoma? 31 1 A. I'd have to look at my curriculum vitae. I 2 don't know. I've published papers in a number of areas 3 in hematology. 4 Q. Well, let me hand it to you there (tendering 5 document). 6 A. Look and see. 7 Q. Doctor, while you're looking through that, do 8 you have any problem with Mr. Wimberley looking through 9 these piles of documents here? 10 A. Not at all. 11 Q. If it interrupts you in any way, just let me 12 know. Okay? 13 A. Okay. 14 MR. HYDE: Off the record. 15 (AT THIS TIME THERE WAS AN 16 OFF-THE-RECORD DISCUSSION, AFTER WHICH THE 17 PROCEEDINGS RESUMED AS FOLLOWS:) 18 A. Well, the -- One of the papers on my curriculum 19 vitae has to do with chemotherapy studies on 20 Camptothecin, which is an anticancer drug. And this 21 involved studies of patients with a variety of 22 malignancies, including lymphoma. So in a sense that 23 that paper has something to do with treatment of 24 lymphoma. But there are no articles specifically 25 concerning lymphoma. 32 1 (By Mr. Hyde) 2 Q. Have you published any papers that specifically 3 concern gastric lymphoma? 4 A. No. 5 Q. Doctor, do you consider yourself to be a 6 toxicologist? 7 A. No. 8 Q. Do you consider yourself to be an 9 epidemiologist? 10 A. No. 11 Q. Do you consider yourself to be an industrial 12 hygienist? 13 A. No. 14 Q. And you have a medical degree from what 15 university? 16 A. Baylor Medical School. 17 Q. And what year did you graduate? 18 A. 1966. 19 Q. And I suppose you did internships or 20 residencies, correct? 21 A. Yes. 22 Q. In what specific areas? 23 A. In internal medicine. 24 Q. And where? 25 A. At the Baylor-affiliated hospitals, which 33 1 consist of the Ben Taub Hospital, the Veterans Hospital, 2 and Methodist Hospital. 3 Q. And out of your work with internal medicine, I 4 take it that somehow you landed in hematology. 5 A. Yes. 6 Q. In medical school did you study hematology? 7 A. Yes. 8 $Q. What textbooks did you use concerning internal 9 medicine? 10 A. Well, at that time the most commonly used 11 textbooks were either Cecil and Loeb, which was a common 12 internal medicine text, or Harrison. Those were 13 probably the two widest texts in use at that time. 14 Q. And I take it that you still have those books 15 somewhere in your files? 16 A. Well, newer editions of them. The original 17 ones are long gone. 18 (AT THIS TIME NATELSON EXHIBIT NOS. 3 19 AND 4 WERE MARKED FOR IDENTIFICATION 20 PURPOSES AND AER FULLY DESCRIBED IN THE 21 "EXHIBIT INDEX" HEREIN. SAME WILL BE FOUND 22 AT THE CONCLUSION OF THIS DEPOSITION.) 23 Q. Doctor, I've had marked as Exhibit 3 A Textbook 24 Of Medicine edited by Cecil and Loeb. And I've had 25 specific portions of the 1953 reprint copied and 34 1 included in Exhibit 3. And I've also had marked as 2 Exhibit 4 Principles Of Internal Medicine, 3 Editor-in-Chief Dr. Harrison, a 1952 reprint, 4 specifically the section dealing with chemical agents. 5 And I'll give you a chance to look at those if you want 6 to go off the record. Would that be all right? 7 A. Oh, certainly. 8 (AT THIS TIME THERE WAS AN 9 OFF-THE-RECORD DISCUSSION, AFTER WHICH THE 10 PROCEEDINGS RESUMED AS FOLLOWS:) 11 A. Okay. 12 Q. Doctor, looking at Exhibit 3, which is Cecil 13 and Loeb's book on internal medicine, on Page 511 14 there's a section on benzene poisoning, correct? 15 A. Yes. 16 Q. And it states, "Benzene (benzol, C6H6, to be 17 distinguished from petroleum benzine) is, with 18 disturbing frequency, the cause of serious and even 19 fatal poisoning." That's a correct reading, isn't it? 20 A. That's correct. 21 Q. I take it that when you were at medical school, 22 you learned that benzene was capable of causing serious 23 and even fatal conditions. 24 A. Yes. 25 Q. And that would have been something that you 35 1 would have learned in the 1960s time period, correct? 2 A. Yes. 3 Q. It further states, "Chronic poisoning -- And 4 I'm reading right here on the right-hand column 5 "Chronic poisoning or subacute poisoning is much more 6 frequent and is manifested usually after days or months 7 of exposure to benzene." That's a correct reading? 8 A. Yes. 9 Q. And that's something you knew while you were in 10 medical school, correct? 11 A. Yes. 12 Q. It further states -- And I'm skipping a few 13 lines -- "Abdominal pain and gastro-intestinal 14 irritation with nausea and vomiting are common:" Is 15 that a correct reading? 16 A. Yes. 17 Q. And that's something you were aware of when you 18 were in medical school, correct? 19 A. Yes. 20 Q. It further states, "The blood picture -- going 21 down to the next paragraph, "The blood picture may vary 22 considerably from the so-called classical changes. 23 Leukopenia, neutropenia, thrombocytopenia, hypochromia, 24 eosinophilia, and anemia may or may not be present. The 25 bone marrow may be affected, or it may be aplastic" -- 36 1 Excuse me. "The bone marrow may not be affected, or it 2 may be aplastic, hyperplastic or leukemic." Is that 3 correct? 4 A. Correct. 5 Q. And that's information you knew when you were 6 in medical school 7 A. Yes. 8 Q. -- correct? It further states in the next 9 midsection under Diagnosis, the last sentence on Page 10 511, "A history of ben -- A history of exposure to 11 benzol should be the determining factor in the diagnosis 12 of benzene poisoning." Is that a correct reading? 13 A. Yes. 14 Q. And you knew that when you were in law school; 15 is that -- Excuse me. You knew that when you were in 16 medical school, correct? 17 A. Yes. 18 Q. Thank God you didn't go to law school. Let's 19 turn over here to Exhibit 4, Doctor, which is 20 "Principles of Internal Medicine," edited by Dr. 21 Harrison. Again, that was a book you used in medical 22 school, correct? 23 MR. FAULK: Well, objection. Not this 24 particular edition, I think, would be more 25 fair. 37 1 Q. It is a book that you used in medical 2 school -- maybe not this edition but you used Harrison, 3 correct? 4 MR. FAULK: And I'm going to object to 5 the question again still because the 6 question necessarily infers or implies that 7 the text remained the same throughout all 8 the editions. If you can give him a text 9 of an edition that he used in medical 10 school, you can then examine that. But I 11 think it's unfair to characterize it any 12 other way. 13 Q. Let's phrase it this way, Doctor. 14 A. Yes. 15 Q. One of the books you used in medical school 16 concerning internal medicine during the 1960s was 17 Harrison's book on internal medicine, true? 18 A. No. That's actually false. Cecil and Loeb. I 19 didn't know Harrison until I was out of medical school. 20 Q. Were you in your residency or internship when 21 you owned the Principles Of Internal Medicine book by 22 Harrison? 23 A. I was probably in my residency. 24 Q. And that would have been, again, in the late 25 1960s? 38 1 A. Yes. 2 Q. Now, from this 1952 edition of Harrison's 3 Principles of Internal Medicine book, on Page 731 4 there's a section concerning chemical agents. Do you 5 see that? 6 A. Yes. 7 Q. And it's authored by Dr. Marshall Clinton. Do 8 you see that? 9 A. Well, it doesn't give his title as to his 10 degree. It just says "Marshall Clinton." I don't 11 know 12 Q. Did you know that Dr. Marshall Clinton was at 13 one time affiliated with Mobil Oil? 14 A. No. 15 Q. Did you know that Dr. Marshall Clinton was the 16 physician who compiled the information for the 1948 17 American Petroleum Institute toxicological review for 18 benzene? 19 A. No. 20 Q. On Page 738 of this edition of Principles of 21 Internal Medicine by Harrison, it states under the 22 section for benzene poisoning, "Benzene may in addition 23 produce serious, even fatal, delayed poisoning following 24 repeated exposure to very low concentrations which may 25 escape sensory detection." That's a correct reading, 39 1 correct? 2 A. Yes. 3 Q. As we sit here today, Doctor, do you know what 4 the odor threshold is for benzene? 5 A. I don't recall it. I can speculate. I've seen 6 the number, but I don't recall the exact number. It's 7 in some of my references. 8 Q. Doctor, you have had patients who have been 9 exposed to benzene, correct? 10 A. Yes. 11 Q. And you have on occasion attributed benzene 12 exposure as a cause of their blood disorder, correct? 13 A. Yes. 14 Q. And I think you've testified in the past that 15 you recall one case where an individual was diagnosed 16 with myelodysplastic syndrome and had a history of 17 exposure to benzene, correct? 18 A. Among other chemicals, yes. 19 Q. And I think you also testified that one of your 20 patients developed myelofibrosis and had .a history of 21 exposure to benzene, correct? 22 A. Yes. 23 Q. At the time when you attributed benzene 24 exposure as a cause of either the myelodysplasia or 25 myelofibrosis, did you attempt to determine the level of 40 1 benzene exposure that these individuals had 2 A. Well, in the case of the person who had 3 myelodysplasia or erythroleukemia, I had his plant 4 records, which showed numerous drops in his white blood 5 cell count, indicating that he'd had enough exposure to 6 make the blood counts abnormal and then allow them to 7 recover when he was taken out of the atmosphere. I did 8 not have any data as to what levels of benzene were 9 measured at that time. 10 In the case of the other fellow I think I 11 mentioned, I did not have any levels of benzene: but we 12 had history that he'd been made sick from benzene 13 exposure. 14 Q. Some kind of acute 15 A. Acute 16 Q. -- illness? 17 A. -- illnesses, yes. 18 Q. Certainly, if an individual could smell benzene 19 in the air, you as a physician would recognize that that 20 individual may be overexposed to benzene, true? 21 A. Probably, yes. 22 Q. Further, on Page 738 on the right-hand column 23 under Chronic Benzene Poisoning, it states, "Chronic 24 benzene poisoning results from repeated or continuous 25 exposure to relatively low concentrations of benzene 41 1 vapor. The level and degree of exposure necessary to 2 produce poisoning apparently vary widely." Do you agree 3 with that statement, sir? 4 A. It depends what kind of poisoning you're 5 talking about. 6 Q. Well, they're talking about chronic poisoning 7 now. 8 A. Well, but, I mean, what -- what result of 9 chronic poisoning? Leukemia? Aplastic anemia? 10 Myelofibrosis? I mean, what -- what exactly are you 11 referring to here? 12 Q. As a general proposition, do you agree with 13 that statement? 14 A. As a general proposition, I think that we 15 believe now that very high levels of benzene exposure, 16 probably in the range of 1 to 200 parts per million over 17 time, can -- can produce leukemia; but very low levels 18 probably do not. 19 Q. Doctor, what study can you point me to that 20 would support your opinion that exposures at 1 to 200 21 parts per million are necessary in order to cause a 22 hematological disorder or blood disorder such as 23 leukemia? 24 MR. FAULK: I'm going to object to the 25 question because his answer was 42 1 specifically limited to leukemia. I think 2 your question's broader. He hasn't 3 expressed an opinion in regard to some of 4 these other 5 Q. You may answer, Doctor. 6 A. In the case of acute leukemia, Dr. Wong has 7 written a number of epidemiologic papers. There have 8 been many others. There's papers by Paxton dealing with 9 the exposure at the pliofilm plants, and I would have in 10 my files a number of papers that would indicate that 11 leukemia is really caused by -- by high total exposures: 12 in other words, high exposures over short periods of 13 time or low exposures over very long periods of time so 14 that you accumulate a large amount of benzene part per 15 million years, so to speak. 16 Q. So Dr. Wong is someone who you consider 17 authoritative in the field of benzene-related 18 epidemiology; is that correct? 19 A. He's published many papers in the area of 20 epidemiology relating to leukemia. And as to whether 21 he's authoritative, I don't know that I look at anybody 22 as authoritative. But he's written a lot of papers in 23 the area. 24 Q. Have you ever had an opportunity to speak with 25 Dr. Wong? 43 1 A. No. 2 Q. Have you seen Dr. Wong's report in this case? 3 A. Yes. 4 Q. Have you been provided with any other 5 statements made by Dr. Wong Strike that. Have you 6 been made -- Strike that. Has Mr. Faulk provided to you 7 the statements that Dr. Wong made to OSHA at the 8 hearings concerning the benzene standard back in the 9 1984 time period? 10 A. Not to my knowledge. 11 Q. Have you ever reviewed the OSHA benzene 12 standard, specifically the preamble, that concerns 13 benzene and cancer? 14 A. I probably have at some time in the past. 15 I -- It hasn't been recently. 16 Q. Do you recall any statements attributed to Dr. 17 Wong in the OSHA benzene standard, specifically the 18 preamble? 19 A. No. 20 Q. So that I'm correct, benzene may cause leukemia 21 when there's a high total exposure -- And I'm not going 22 to misquote you in any way. So, you know, if I do, I 23 would like for you to correct me. But I want to make 24 sure I understand this. 25 MR. FAULK: Well, I am going to object 44 1 that that mischaracterizes his testimony as 2 to a general category of leukemia. 3 MR. HYDE: I wasn't finished. 4 MR. FAULK: Okay. 5 (By Mr. Hyde) 6 Q. But as it relates to, I think you said, acute 7 myelogenous leukemia and benzene exposure, you look at 8 exposure in two different ways, one being a high level 9 of exposure for either a long or short period of time or 10 lower exposure levels over a long period of time. And 11 those would be factors that you would be considering as 12 to whether or not an acute myelogenous leukemia was 13 caused from benzene exposure, correct? 14 A. Those would be in part what I would consider, 15 yes. 16 Q. And I take it that -- Well, is it your position 17 that -- in order for you to attribute benzene exposure 18 as a cause of acute myelogenous leukemia, is there any 19 requirement of any precursor conditions such as aplastic 20 anemia or myelodysplastic syndrome or some other type of 21 blood dyscrasia? 22 A. No. In other words, the leukemia caused by 23 benzene may have a myelodysplastic phase but doesn't 24 necessarily have a myelodysplastic phase. 25 Q. In the 1953 edition -- Strike that. In the 45 1 1952 edition reprint of Harrison's book on internal 2 medicine, on Page 738 it states, "Inasmuch as the body 3 develops no tolerance to benzene, it is generally 4 considered that the only absolutely safe concentration 5 for benzene is zero." That's a correct reading, isn't 6 it? 7 A. I'm not following where you are here. 8 MR. FAULK: Which page are you on, 9 Keith? 10 MR. HYDE: 738 11 THE WITNESS: He said 738. 12 MR. HYDE: -- on the right-hand side. 13 (By Mr. Hyde) 14 Q. It says, "The American Standards Association" 15 on top of the paragraph, about halfway down in the 16 paragraph. See, I've got it marked here, Doctor 17 (indicating). Look. 18 A. Yes. I think I see. 19 Q. It states -- And so the question's clear, on 20 Page 738 of Harrison's book on internal medicine, 21 specifically the 1952 edition, it states, "Inasmuch as 22 the body develops no tolerance to benzene, it is 23 generally considered that the only absolutely safe 24 concentration for benzene is zero." That's a correct 25 reading, isn't it? 46 1 A. Yes. 2 Q. Have you heard that before today? 3 A. I don't recall that -- having heard that 4 before. 5 Q. On .the next page, Page 739, under Chronic 6 Benzene Poisoning on the left-hand side, it states, 7 "Chronic benzene poisoning is more frequent, more 8 insidious, and usually more serious than acute benzene 9 poisoning." That's a correct reading, isn't it? 10 A. Again, I'm not certain where you are. 11 MR. FAULK: Which paragraph, Keith? 12 Q. (Indicating.) 13 A. Oh, the other side. That's what it says. 14 "Chronic benzene poisoning is more frequent, more 15 insidious, and usually more serious than acute benzene 16 poisoning." 17 Q. Dr. Natelson, you certainly are aware that the 18 diseases or conditions associated with benzene exposure 19 are serious and life-threatening. 20 A. Benzene exposure at certain levels can result 21 in life-threatening illnesses. 22 Q. Including death? 23 A. Including death. 24 Q. And exposures to benzene may pose a substantial 25 risk of harm to the worker exposed to benzene, correct? 47 1 A. Depending on the levels exposed to. 2 Q. Have you ever seen any risk assessment data 3 concerning worker exposure to benzene and the risk of 4 harm associated with those benzene exposures? 5 A. Well, I've seen epidemiologic articles talking 6 about -- as the ones we've commented from Dr. Wong and 7 others, about what chronic-type exposures have caused 8 acute myeloplastic leukemia. 9 MR. HYDE: Let me -- I need to object. 10 (By Mr. Hyde) 11 Q. I guess I want to be very clear. I'm not 12 talking about an epidemiological study. I'm talking 13 about a risk assessment based on certain risk assessment 14 principles. Do you recall reading any study dealing 15 with risk assessment and exposure to benzene? 16 A. You'd have to -- I may have. You'd have to 17 show me a specific article you're talking about. 18 Q. As we sit here today, does that specifically 19 ring a bell that you've read a study concerning risk 20 assessment and benzene? 21 A. No, not particular. 22 MR. HYDE: Off the record for a 23 second. 24 (AT THIS TIME THERE WAS AN 25 OFF-THE-RECORD DISCUSSION, AFTER WHICH THE 48 1 PROCEEDINGS RESUMED AS FOLLOWS:) 2 (By Mr. Hyde) 3 Q. Doctor, what is your understanding of when 4 chronic benzene poisoning was first reported in the 5 medical literature? 6 A. Well, you've shown me articles written here in 7 the 1950s that talk about it. I believe we knew 8 aplastic anemia could be caused from benzene much 9 earlier than that. I don't know the exact initial 10 publication on benzene poisoning. 11 Q. Have you ever used a textbook by Dr. Wintrobe 12 entitled, "Clinical Hematology"? 13 A. Yes. 14 (AT THIS TIME NATELSON EXHIBIT NO. 5 15 WAS MARKED FOR IDENTIFICATION PURPOSES AND 16 IS FULLY DESCRIBED IN THE "EXHIBIT INDEX" 17 HEREIN. SAME WILL BE FOUND AT THE 18 CONCLUSION OF THIS DEPOSITION.) 19 Q. Doctor, I've had marked as Exhibit 5, Dr. 20 Wintrobe's book on Clinical Hematology dated 1942. Do 21 you see that, sir? 22 A. Yes. 23 Q. And there's a section from that textbook on 24 Page 394 concerning aplastic anemia. Do you see that 25 section? 49 1 A. Yes. 2 Q. On this 3 MR. FAULK: I'm going to object to the 4 line of questioning because it lacks a 5 foundation that this is the edition that 6 the doctor has referred to and used. 7 Q. In the 1942 edition of Wintrobe's -- Dr. 8 Wintrobe's book on clinical hematology, there's a 9 section concerning benzol, correct? 10 A. Yes. 11 Q. And, of course, you understand benzol to be 12 benzene. 13 A. Yes. 14 Q. And it states on Page 395, "Benzene has been 15 known as a cause of fatal aplastic anemia since 16 Santesson's description (1897) of 4 cases in workers in 17 a bicycle tire factory." That's correct, isn't it? 18 A. Yes. 19 Q. Were you aware that cases of aplastic anemia 20 were first reported in 1897 involving workers exposed to 21 benzene? 22 A. No. 23 Q. What textbooks do you now use, Doctor, in your 24 work as a hematologist? 25 A. Well, I have Wintrobe's textbook in my office. 50 1 I also have Williams' textbook of hematology. I have 2 another one with a red cover. I'm blanking out on the 3 lead author. 4 Q. Would that be Dr. Hoffman or Dr. Jandel? 5 A. No. Dr. Hoffman's is one. But when you say 6 use, the use of textbooks has become less and less 7 useful, you might say, to a practicing physician because 8 of the fact that we normally use the medical literature, 9 which is more up to date: and textbooks are typically 10 several years behind the medical literature. And so 11 periodically we'll buy a new textbook, but the amount of 12 time that we use it is on rare occasions as a reference 13 matter. 14 Q. The textbooks that you have available to you in 15 your office or in your practice include Dr. Williams' 16 book on hematology, Dr. Wintrobe's book on hematology, 17 and Dr. Hoffman's book on hematology: is that correct? 18 A. Correct. 19 Q. And on occasion you will use these books as 20 references in your work as a hematologist; is that 21 correct? 22 A. Correct. 23 Q. And these books you have found to be 24 authoritative in the field of hematology: is that 25 correct? 51 1 A. No. I wouldn't recognize these books as 2 authoritative. Many times there are errors in them. 3 And -- But they are useful, nevertheless. 4 Q. Now, are you aware as to the classification of 5 benzene by OSHA whether or not benzene is or is not a 6 carcinogen? 7 A. Benzene is considered a carcinogen. 8 Q. And you're familiar with the International 9 Agency for Research on Cancer, otherwise known as IARC, 10 correct? 11 A. Yes. 12 Q. And how does IARC classify benzene as it 13 relates to its cancer-causing properties? 14 A. It's considered to be a carcinogen. 15 Q. And I believe it's a class 1 human carcinogen; 16 is that correct? 17 A. If you say so. 18 Q. Well, I mean 19 A. It's a carcinogen, yeah. 20 Q. Okay. And certainly you have no dispute with 21 OSHA or IARC concerning their classification of benzene 22 as a carcinogen, correct? 23 A. No, none whatsoever. 24 Q. I take it that you know that benzene is harmful 25 to the bone marrow? 52 1 A. Can be. 2 Q. Benzene may be harmful to the DNA? 3 A. Yes, it can be. 4 Q. Why is that important, Doctor? 5 A. Well, the metabolites of benzene are what we 6 call topoisomerase 2 inhibitors. The topoisomerase 7 system has to do with unfolding of DNA so the cells can 8 divide. And there are two forms of topoisomerase: 9 topoisomerase 1 and 2. And benzene, like many of our 10 chemotherapy drugs, is a topoisomerase 2 inhibitor or 11 its metabolites are topoisomerase 2 inhibitors. When 12 you have drugs that are topoisomerase 2 inhibitors, you 13 have drugs that have the potential for causing 14 leukemia -- acute leukemia. 15 Q. Now, the DNA that may be harmed as a result of 16 benzene exposure, that DNA is located in the bone 17 marrow; is that correct? 18 A. Well, DNA is located in every -- most every 19 cell in the body. 20 Q. But of concern, as it relates to benzene, 21 typically has been that benzene exposure may harm the 22 DNA of the cells that are located in the bone marrow. 23 Is that a fair statement? 24 A. That would be a concern, yes. 25 Q. Would there be other concerns as well? 53 1 A. Well, I mean, presumably any cell that can be 2 damaged by inhibition of the DNA replication systems can 3 be damaging to the organism. 4 Q. Now, I'm not going to go in great detail 5 because I really can't. I'm aware of the totipotential 6 stem cell that's located in the bone marrow, correct? 7 A. There are stem cells in the bone marrow, yes. 8 Q. And what is the importance of the stem cell in 9 the bone marrow? 10 A. Well, stem cells are important because they 11 give rise to the mature cells that circulate, but they 12 also have the capacity for reproducing themselves so 13 that you don't run out of gas; in other words, that you 14 don't -- You don't want all of your stem cells to go 15 into circulating cells that will die off. You want some 16 of them to remain and repopulate the bone marrow. 17 Q. So from the stem cells there go different 18 lineages of cells that circulate in the blood, correct? 19 A. Well, as -- as stem cells mature, they go down 20 certain pathways and eventually reach a point where they 21 are committed to go a particular way. Early in their 22 development, they may give rise to different types of 23 cells. 24 Q. But eventually -25 A. Eventually a stem cell leads to a final cell 54 1 that is a dead end that eventually is going to die. 2 Q. And those dead end cells are one of several 3 groups, T-cells, B-cells 4 A. Red blood cells, white blood cells of various 5 kinds, yes. 6 Q. With all these questions that I'm fixing to ask 7 you, because .I can ask them in about like one minute, 8 I'm going to ask you about some conditions 9 hematological conditions or oncology-type cancers. 10 We'll just call them that. I'm going to ask you whether 11 or not you recognize the condition as being associated 12 with exposure to benzene. Now, I know that -- I assume 13 that you would answer the question with sufficient 14 exposure at sufficient duration, you know, those types 15 of questions. I suppose the best way is that I should 16 just go ahead and include that in my question. But I'll 17 try to make this as fast as I can. 18 With sufficient exposure to benzene, you 19 recognize an association with benzene in myelodysplastic 20 syndrome: is that correct? 21 A. That is correct. 22 Q. And you recognize benzene as a cause of 23 myelodysplastic syndrome. 24 A. Yes. 25 Q. With sufficient exposure you recognize that 55 1 benzene is a cause of acute myelogenous leukemia. 2 A. Yes. 3 Q. With sufficient exposure you recognize that 4 benzene is a cause of aplastic anemia. 5 A. Yes. 6 Q. With sufficient exposure do you recognize an 7 association with benzene and acute lymphocytic leukemia? 8 A. No. 9 Q. Do you recognize an association between 10 exposure to benzene and chronic myelogenous leukemia? 11 A. No. 12 MR. FAULK: You didn't -- Well, okay. 13 That's fine. You didn't preface it with 14 sufficient exposure. 15 MR. HYDE: Yeah. Well, if I thought 16 that he would answer it differently, I 17 would maybe ask it that way. 18 MR. FAULK: Need to be consistent, 19 though. 20 (By Mr. Hyde) 21 Q. Do you recognize an association between benzene 22 and chronic lymphocytic leukemia? 23 A. No. 24 Q. With sufficient exposure to benzene, do you 25 recognize benzene as a cause of myelofibrosis? 56 1 A. Yes. 2 Q. With sufficient exposure do you recognize 3 benzene as a cause of thrombocytopenia? 4 A. Yes. 5 Q. With sufficient exposure do you recognize 6 benzene as a cause of leukopenia? 7 A. Yes. 8 Q. Doctor, have you read any documents that 9 suggest that exposure to benzene is a cause of 10 non-Hodgkin's lymphoma? 11 MR. FAULK: I want to object because 12 the term "suggest" is vague. 13 A. Well, there are many suggestions as to the 14 cause of non-Hodgkin's lymphoma: and many papers have 15 been written on the subject. And certain papers, 16 particularly epidemiologic studies, have suggested that 17 chemicals, including benzene, might be a cause of 18 non-Hodgkin's lymphoma. And I have seen such studies, 19 yes. 20 Q. Now, in the United States there are two sources 21 of information that industrial hygienists go to as it 22 concerns exposure levels -- or limits for workers 23 exposure -- exposed to certain chemicals, those being 24 OSHA, Occupational Safety and Health Administration, and 25 the American Conference of Governmental Industrial 57 1 Hygienists. Are you aware of those two organizations? 2 A. Yes. 3 MR. FAULK:. I'm going to object to the 4 question because his awareness of the 5 organizations is apparently the question. 6 And he testified about a number of things 7 that -- I think the question's misleading 8 and bad form. 9 A. I have heard of both these organizations. 10 Q. And I understand that you're not an industrial 11 hygienist and certainly don't mean to represent by that 12 question that you are an industrial hygienist or that 13 you hold yourself out to be a specialist in industrial 14 hygiene. Do you understand that? 15 A. Correct. 16 MR. HYDE: Mark that for me, please. 17 (AT THIS TIME NATELSON EXHIBIT NO. 6 18 WAS MARKED FOR IDENTIFICATION PURPOSES AND 19 IS FULLY DESCRIBED IN THE "EXHIBIT INDEX" 20 HEREIN. SAME WILL BE FOUND AT THE 21 CONCLUSION OF THIS DEPOSITION.) 22 (By Mr. Hyde) 23 Q. Dr. Natelson, I've had marked as Exhibit 6 the 24 Notice Of Intended Changes For Benzene from the Applied 25 Occupational Environmental Hygiene magazine, July of 58 1 1990, which is the magazine of the American Conference 2 of Governmental Industrial Hygienists. And I'm going to 3 ask if you've ever seen this document before. 4 A. If I have, I don't recognize it. 5 Q. Let me see it, please. 6 A. (Tendering document.) 7 Q. On Page 459 on Exhibit 6 on the right-hand 8 column, it states -- I'll read it to you -- "Prolonged 9 cumulative exposures were judged more important for 10 human benzene carcinogenicity than maximum peak 11 exposures, and the authors concluded that there was a 12 significant association between occupational benzene 13 exposure and the occurrence of leukemia, all 14 lymphopoietic cancers, and non-Hodgkin's lymphopoietic 15 cancers." Have you ever heard that before today? 16 A. Well, as I mentioned, I've seen epidemiologic 17 studies that suggest that non-Hodgkin's lymphoma can be 18 caused by benzene. 19 Q. Now, I'm going to have marked as the next 20 exhibit 21 MR. FAULK: I Object to that answer as 22 being nonresponsive. 23 MR. HYDE: What number are we on? 24 COURT REPORTER: 7. 25 MR. HYDE: 7. Go ahead and mark this, 59 1 please. 2 (AT THIS TIME NATELSON EXHIBIT NO. 7 3 WAS MARKED FOR IDENTIFICATION PURPOSES AND 4 IS FULLY DESCRIBED IN THE "EXHIBIT INDEX" 5 HEREIN. SAME WILL BE FOUND AT THE 6 CONCLUSION OF THIS DEPOSITION.) 7 (By Mr. Hyde) 8 Q. Doctor, do you recall seeing any studies from 9 Dow Chemical concerning workers exposed to benzene who 10 had chromosomal aberrations attributed to benzene 11 exposure at levels of exposure as low as 5 parts per 12 million? Have you ever seen such a study? 13 A. I don't recall. 14 Q. Now, earlier you talked about a Dr. Wong and 15 some of the research that you've read from Dr. Wong. 16 And in Exhibit 7, which is the OSHA regulation for 17 benzene dated September 11th, 1987, on Page 34,475 in 18 the middle of the page, there's a quote concerning Dr. 19 Wong. And it states, "As a result of the analyses, 20 Wong, et al., concluded that there was a significant 21 association between occupational exposure to benzene and 22 leukemia, all lymphopoietic cancers, as well as 23 non-Hodgkin's lymphopoietic cancer." That's a correct 24 reading, isn't it? 25 A. Yes. 60 1 MR. FAULK: Can we get the question 2 read back? I want to -- Are you saying 3 this -- Well, just a second. Are you 4 saying this is a quote from Dr. Wong or a 5 quote from the standard? 6 MR. HYDE: OSHA standard. 7 MR. FAULK: Okay. Fine. 8 (By Mr. Hyde) 9 Q. Now, and that is a similar quote to what was in 10 the ACGIH Notice Of Intended Change document which has 11 been marked Exhibit 6, correct? 12 A. Yes. 13 (AT THIS TIME NATELSON EXHIBIT N0. 8 14 WAS MARKED FOR IDENTIFICATION PURPOSES AND 15 IS FULLY DESCRIBED IN THE "EXHIBIT INDEX" 16 HEREIN. SAME WILL BE FOUND AT THE 17 CONCLUSION OF THIS DEPOSITION.) 18 Q. Now, Exhibit 8 is a document I received from 19 Dr. Dement at Duke University. Do you know Dr. Dement? 20 A. No. 21 Q. Have you ever heard of Dr. Dement? 22 A. No. 23 Q. This is a study that Dr. Dement sent me that is 24 entitled, "Proportional Mortality Ratio (PMR) Analysis 25 of Crown Zellerbach Death Certificates, 1981 through 61 1 1985, Final Report," dated June 2nd, 1987. And one of 2 the authors of that document was Dr. Otto Wong, while he, 3 was with Environmental Health Associates. I'm going to 4 ask if you have ever seen this document before today. 5 A. No. 6 Q. Doctor, I'm going to turn to Page 9 in a 7 second. If I can, I'll 8 A. I have mine. 9 Q. On Page 9 in the second full paragraph, the 10 paragraph starts off, "For lymphopoietic cancer and 11 diseases." I'm going to move on later on into the 12 paragraph. And it states, "There has been at least two 13 previous reports of excess lymphopoietic cancer in pulp 14 and paper workers. (Robinson 1983, Milham 1984). These 15 disease are usually associated with solvents, especially 16 benzene." And my question is: Have you ever seen this 17 document where Dr. Wong states that lympho -- lympho 18 I can't say it -- lymphopoietic cancers are usually 19 those types of diseases associated with solvents, 20 especially benzene? 21 A. I have not seen this article or that statement. 22 Q. Do you disagree with what Dr. Wong said in 23 1987? 24 MR. FAULK: I'm going to object that 25 the term "lymphopoietic cancer" is not a 62 1 sufficiently specific category to answer 2 any questions about it. 3 (By Mr. Hyde) 4 Q. You may answer, Doctor. 5 A. You know, I would -- I would agree lymph -6 This Dr. Wong presumably is an epidemiologist, and 7 I'd -- I'd like to know what he includes under that 8 category. That's -,- That could include a number of 9 things. 10 Q. I think he states on Page 9, "The disease 11 category for lymphopoietic cancer includes both the 12 lymphomas and leukemias." That's a correct reading, 13 isn't it? 14 A. That's correct. 15 Q. Do you have any disagreement with that? 16 A. Well, I think that to lump leukemia in with 17 lymphoma, you've got apples and oranges there. And so 18 obviously he's putting apples and oranges together. 19 That's what he's saying. 20 Q. Doctor, have you -- Well, never mind. 21 MR. HYDE: Let's go ahead and mark it. 22 (AT THIS TIME NATELSON EXHIBIT NO. 9 23 WAS MARKED FOR IDENTIFICATION PURPOSES AND 24 IS FULLY DESCRIBED IN THE "EXHIBIT INDEX" 25 HEREIN. SAME WILL BE FOUND AT THE 63 1 CONCLUSION OF THIS DEPOSITION.) 2 (By Mr. Hyde) 3 Q. Am I correct then, Doctor, that you would 4 disagree with the inclusion of lymphomas and leukemias 5 as lymphopoietic cancer 6 MR. FAULK: Well, I'm going to 7 object 8 Q. -- such that -- such as what Dr. Wong included 9 in his report in June of 1987? Do you disagree with 10 that category? 11 MR. FAULK: Well, I'm going to -- I'm 12 going to object to the question unless you 13 specify whether you're asking him as an 14 epidemiologist or as a clinician. I think 15 that he's testified that they're apples and 16 oranges. And I think the question is 17 misleading. 18 Q. As a physician, Doctor. 19 A. As a physician, if you put two different 20 diseases in the same category and one disease has a high 21 incidence of something related to a particular chemical 22 and you lump the two together, you're dragging one in 23 with the other. In other words, you have to look at 24 these things separately. If you have a large number of 25 - leukemia cases and no lymphoma cases and you put your 64 1 lymphomas in with your leukemias, everything might look 2 elevated: but it may have nothing to do about lymphoma. 3 Q. It might be just the opposite. You might have 4 a lot of lymphomas and no leukemias and have the same 5 elevation but it be attributable to the lymphomas, 6 correct? 7 A. Correct. 8 Q. And as it relates to -- Well, strike that,. Dr. 9 Natelson, I'm going to show you Exhibit 9. And I'm 10 going to ask you if you have ever seen this document 11 before. 12 MR. FAULK: Dr. Natelson -- Off the 13 record. 14 (AT THIS TIME THERE WAS AN 15 OFF-THE-RECORD DISCUSSION, AFTER WHICH THE 16 PROCEEDINGS .RESUMED AS FOLLOWS:) 17 MR. FAULK: Back on the record. 18 A. I may have seen this article. I would think I 19 probably have seen this article at some time. 20 Q. I take it that you also have treated patients 21 with lung cancer? 22 A. On rare occasion. I don't see a lot of 23 patients with solid tumors unless they have some unusual 24 circumstance. 25 Q. But you as a physician -- Strike that. Do you 65 1 recognize that cigarette smoking causes lung cancer? 2 A. Yes. 3 Q. And do you know what the SMRs or standard 4 mortality ratios are as it concerns deaths from lung 5 cancer amongst cigarette smokers? 6 A. No. 7 Q. Is there any particular level of an SMR that 8 you as a physician use when you want to establish 9 whether or not a certain condition or cancer may be 10 caused by some bacteria or environmental agent like a 11 chemical? 12 A. Well, we have recognized that epidemiologic 13 studies have many problems because of inaccurate death 14 certificates -- if their based on death certificates, 15 inaccurate data. And so if you want to be certain that 16 an epidemiologic or a mortality rate is significant 17 relating a chemical to a particular disease, what you'd 18 like to see are consistent studies; in other words, that 19 several people conduct the same kind of study and find 20 the same basic number. And you'd like to see that 21 number at least three times what -- what the expected 22 would be. 23 Q. But I take it that also you take into 24 consideration the power of a study when looking for a 25 cause of a certain condition or illness, correct? 66 1 A. Well, that's one thing that you take into 2 consideration. But if you have ten bad studies and put 3 them together, now you've got one big bad study. So, I 4 mean, it depends on the particular studies you're 5 looking at. 6 Q. Well, for instance, if you had a well-run, 7 well-designed study that had a million people in it and 8 there was an SMR of 1.1, that may be statistically 9 significant, correct? 10 A. It might to an epidemiologist. 11 Q. In other words, if you look at a million people 12 and you expect a certain condition in 100,000 but 13 actually you see it in 110,000, it may be significant 14 that there are 10,000 more people with this condition or 15 cancer than what was expected. That might be 16 statistically significant, correct? 17 MR. FAULK: I'm going to object until 18 you lay a foundation that he's qualified to 19 express opinions as an epidemiologist. 20 Q. As a physician, Doctor. 21 A. As a physician, if you told me that something 22 was 1.1 higher than normal, I'd say it's utter nonsense. 23 Q. Now, if in the population of this million 24 people only 50,000 had exposure to a specific etiologic 25 agent and there were 10,000 more deaths amongst those 67 1 50,000, that may be significant to you, correct 2 MR. FAULK: Same objection. 3 Q. -- as a physician? 4 A. Now, let's see. You have to-run that one by 5 again. You've got 50,000 people now 6 Q. Within the million-person cohort. 7 A. . All right. 8 Q. But those 50,000 actually had exposure to some 9 agent. I'm not going to say whether it's chemical or 10 whatever. But within those 50,000, we had 10,000 11 diseases or deaths. That may be significant to you. 12 A. If you have 10,000 people getting an illness in 13 a group of only 50,000, that would seem very impressive.', 14 Q. Now, first of all, let's go back to this study 15 here. Exhibit 9 -16 MR. FAULK: You want to refresh his 17 recollection as to what it is? 18 MR. HYDE: Yes, sir, I will. 19 (By Mr. Hyde) 20 Q. It's entitled, "Benzene and the Dose-Related 21 Incidence of Hematologic Neoplasms in China." The first 22 investigator is Richard B. Hayes. And you said you may 23 have seen this document before, correct? 24 A. Yes. 25 Q. One of the conclusions from Exhibit 9, the 68 1 report by Hayes, is that workers with ten or more years 2 of benzene exposure had a relative risk of developing 3 non-Hodgkin's lymphoma of 4.2, 95 percent confidence 4 interval 1.1 through 15.9. Have you ever seen that 5 specific conclusion before, Doctor? 6 A. Well, I think I've seen this paper. So I think 7 I would have seen that conclusion. 8 Q. Certainly when -- Because when I asked you 9 earlier, you indicated you like to see consistent 10 studies with three times odds ratio or SMRs, whatever, 11 that that would be significant to you, correct? 12 A. Yes. 13 Q. Certainly when you see an SMR relative risk of 14 4.2, that certainly rings of significance to you, 15 doesn't it? 16 MR. FAULK: I'm going to object 17 because 18 Q. As a physician. 19 MR. FAULK: I'm still going to object 20 because your previous question was prefaced 21 with consistency. And you haven't laid a 22 foundation showing that this study is 23 consistent with anything. 24 A. Well, it depends, again, on the type of study. 25 If the study is one that I considered well done and came 69 1 up with a result of four times the incidence, I would 2 think that would be suggestive. I would like to see 3 other studies show the same thing; but, again, it would 4 depend on the quality of the study. 5 Q., Do you have any evidence that the study which 6 has been marked as Exhibit 9, the study by Dr. Hayes, 7 that this study is not a competently designed and 8 carried out study? 9 A. Yes. 10 Q. What evidence do you have, sir? 11 A. I just visited in China, and I was there for 12 two weeks at several of the universities lecturing and 13 saw what kind of medical care they get, what kind of 14 universities they have, and what kind of recordkeeping 15 they have. And I would -- wouldn't believe a piece -- a 16 speck of fly on that paper. 17 Q. So the basis of your criticisms of this report 18 by Dr. Hayes is your recent visit to China and your 19 knowledge of their medical system, correct? 20 A. In part. Dr. Wong points out other features 21 about the fact that, for example, the diagnosis of 22 lymphoma, I think he mentioned, could only be verified 23 60 percent of the time when the slides were looked at. 24 And I would -- I'm surprised it's that good after seeing 25 what I saw. So I would think that the data collection 70 1 here would be extremely invalid. Plus, the conditions 2 there are so unique that they would probably have no 3 bearing on what we see here in the United States. The 4 level of pollution in these cities there is staggering. 5 We don't have anything like it comparable in the United 6 States. So I think whatever conclusions they would 7 might find in China would have very little bearing about 8 what happens in the United States. 9 Q. What information or evidence do you have as it 10 concerns ambient benzene levels in the environment in 11 China as compared to the levels of benzene present in 12 Jefferson County, Texas? 13 A. I have no specific information about benzene 14 levels there versus Jefferson County. 15 Q. You understand that the last day that Mr. 16 Barrett worked as a pipe fitter he was on a benzene 17 tower at the Mobil chemical plant in Beaumont and that 18 that tower caught on fire, and Mr. Barrett spent over 50 19 days in the hospital for his wounds. Did you know that? 20 A. Yes. 21 Q. And as we sit here today, you have no idea of 22 the level of benzene Mr. Barrett was exposed to before 23 and during that fire on the benzene tower at Mobil, 24 correct? 25 A. That is correct. 71 1 (AT THIS TIME NATELSON EXHIBIT NO. 10 2 WAS MARKED FOR IDENTIFICATION PURPOSES AND 3 IS FULLY DESCRIBED IN THE "EXHIBIT INDEX" 4 HEREIN. SAME WILL BE FOUND AT THE 5 CONCLUSION OF THIS DEPOSITION.) 6 (By Mr. Hyde) 7 Q. Doctor, this is Exhibit 10, which is the 8 Updated Mortality Study of Workers at a Petroleum 9 Refinery in Beaumont, Texas, by Dr. Raabe and others. 10 And I'll represent to you that this is an updated 11 mortality study of the Mobil - Beaumont refinery. And, 12 as I understand it, you've not seen this document: is 13 that correct? 14 A. That's correct. 15 Q. May I see it, Doctor? 16 A. (Tendering document.) 17 Q. Now, you understand that a pipe fitter is part 18 of maintenance. 19 A. Yes. 20 Q. On Table XIII it's entitled, "Selected 21 Cause-Specific Mortality Among Beaumont Males Employed 22 Greater Than 6 Months in Maintenance Craft Jobs by Hire 23 Period." That's a correct reading, isn't it? 24 A. Yes. 25 Q. Now, lymphoma, specifically non-Hodgkin's 72 1 lymphoma, is included in the category of cancers of 2 other lymphatic tissue. Is that -3 MR. FAULK: I'm going to object 4 because you haven't laid a 5 Q. -- consistent with your understanding? 6 MR. FAULK: I'm going to object 7 because you haven't laid a foundation for 8 that. 9 A. Well, I don't know. It just says "other 10 lymphatic tissue." They don't tell you what that means, 11 whether they've lump -- put chronic lymphocytic leukemia 12 in there, whether Hodgkin's disease is in there, whether) 13 non-Hodgkin's is in there. It doesn't specify what's in 14 there. 15 Q. Well, we see that leukemia is in a category 16 right above other lymphatic tissue, correct? 17 A. Okay. 18 Q. And I'll represent to you that one of the 19 cancers included in cancers of other lymphatic tissue isle 20 non-Hodgkin's lymphoma, and I believe multiple myeloma 21 is also included in that. All right? 22 A. Okay. 23 Q. Now, for workers who worked in maintenance 24 greater than six months prior to 1950, there is an SMR 25 of 205 that is statistically significant for workers at 73 1 Mobil who died of cancers of other lymphatic tissue; is 2 that correct? 3 MR. FAULK: I'm going to object 4 because the question's misleading. You 5 prefaced it by only including two causes of 6 death within the other lymphatic tissue 7 when you know that the document specifies 8 numerous others. 9 MR. HYDE: I don't know that. 10 (By Mr. Hyde) 11 Q. But, Doctor, that's a correct SMR, isn't it? 12 A. I can read the number there. It says 205. 13 Q. And it says it's statistically significant; is 14 that correct? 15 A. ..05 level, yes. 16 Q. And that shows at least a twofold increase in 17 those types of cancers, correct? 18 MR. FAULK: I'll object because the 19 question's vague. What types of cancer is 20 this? No types of cancer are specified on 21 that page. 22 Q. Of other lymphatic tissue. 23 A. It's of whatever other lymphatic tissue is. 24 Q. And we move over to workers who worked more 25 than six months in maintenance at the Mobil refinery who 74 1 were hired after 1950. There is an SMR of 443 under 2 that same category of cancers of other lymphatic tissue; 3 is that correct? 4 A. Yes. 5 MR. FAULK: I'm going to object to the 6 question as being vague: 7 Q. And that would be a fourfold increase over what 8 was expected, correct? 9 A. Of whatever is in that category. 10 Q. All right. Well, overall -- I'm looking at 11 male refinery workers with greater than six months in 12 the Beaumont refinery who had employment greater than 13 six months in maintenance craft jobs for all 14 lymphopoietic cancers, specifically cancer of lymphatic 15 tissue -- there was an SMR of 233. That was 16 statistically significant, correct? 17 MR. FAULK: Again, I object to the 18 question as being vague. The category 19 "other lymphatic tissue" has not been 20 specified to the doctor as to what it 21 includes. And as such the question's 22 misleading. 23 A. Well, I see the 233; and I see that it's 24 statistically significant at the .O1 level. 25 Q. Now, on Table -- And just so -- We were 75 1 referring -- That was Table XII that that question 2 referred to. Now we're looking at Table XIV, which is 3 "Observed and Expected Deaths, SMRs and 95% Confidence 4 Interval for Hematopoietic Cancers-Among Male 5 Maintenance Craftworkers by Duration of Employment." 6 That's a correct reading, isn't it? 7 A. Yes. 8 Q. And there's a section for non-Hodgkin's 9 lymphoma, correct? 10 A. Yes. 11 Q. And for workers who worked less than ten years, 12 there was an SMR of 244; is that correct? 13 A. Yes. 14 Q. And if you worked 10 to 29 years, there was an 15 SMR of 174, correct? 16 A. Yes. 17 Q. And that would represent a 74 percent increase 18 over what was expected, correct? 19 A. Yes. 20 Q. And for the total there was an SMR of 168 of 21 non-Hodgkin's lymphoma amongst maintenance craft workers 22 at the Mobil - Beaumont refinery; is that correct? 23 A. Yes. 24 MR. FAULK: I'm going to object 25 because the question's misleading because 76 1 you're leaving out the confidence 2 intervals, and that's a necessary component 3 for understanding any SMR. 4 COURT REPORTER: And that's 5 MR. FAULK: -- a necessary component 6 for understanding any SMR. 7 Q. And that would represent a 68 percent increase 8 over what was expected in the category of non-Hodgkin's 9 lymphoma amongst the maintenance workers, correct? 10 MR. FAULK: I'm going to object. The 11 question's vague because you're not 12 considering the confidence intervals. 13 Q. You may answer. 14 A. Well, the 168 is higher than 100. 15 Q. Sixty-eight percent higher. 16 A. Yes. 17 Q. Would it be important to you to know how many 18 of the maintenance workers actually worked in the 19 benzene area for those workers who developed' I 20 non-Hodgkin's lymphoma at the Beaumont refinery? Is 21 that something that you as a hematologist would like to 22 know? 23 MR. FAULK: I'm going to object 24 because you've not laid a foundation that 25 the doctor is familiar with the document in 77 1 any degree other than the pages you've 2 shown him, and I think it's manifestly 3 unfair to ask him questions and ask him to 4 interpret ultimate findings from a document 5 without him demonstrating familiarity with 6 it or even the ability to analyze it as an 7 epidemiologist. 8 MR. HYDE: So what your objection 9 is 10 MR. FAULK: My object speaks for 11 itself. 12 MR. HYDE: Okay. 13 (By Mr. Hyde) 14 Q. Doctor, you may answer the question. 15 A. Well, the question -- the question would be, 16 what am I being asked? If I'm being asked something 17 that has to do with acute leukemia, I certainly would be 18 interested in knowing what specific chemicals were 19 involved. It really depends on the question I'm being 20 asked. 21 Q. If you were going to -- Hypothetically 22 speaking, if you as a hematologist were asked to 23 evaluate whether or not benzene played a role in any of 24 the deaths amongst former workers at Mobil from 25 non-Hodgkin's lymphoma, would you want to know how many 78 1 of those workers were exposed to benzene and what the 2 extent and duration of their exposure to benzene was? 3 MR. FAULK: Objection; calls for 4 speculation. 5 A. Well, all data would be useful. You'd like to 6 know that, plus the duration of exposure, plus the 7 latency period between the onset of the illness and 8 their exposure. There are many things you'd like to 9 know, the type of lymphoma. 10 MR. FAULK: You're asking 11 A. The part of the data you'd be looking for. 12 MR. FAULK: You're asking this as a 13 physician? 14 MR. HYDE: Yeah. 15 MR. FAULK: Because I'm going to again 16 object because you've not laid a foundation 17 that physicians do that. Physicians treat 18 patients. Physicians make conclusions 19 based on particular cases. And I don't 20 think you've laid a proper foundation for 21 your question and move to strike the answer 22 on that basis. 23 (By Mr. Hyde) 24 Q. Doctor, have you ever acted as a consultant on 25 behalf of any labor union concerning hematological 79 1 questions? 2 A. No. 3 Q. Have you ever been requested by Mobil to review 4 their medical program as it relates to hematological 5 questions? 6 A. No. 7 Q. Have you been asked by any oil or chemical 8 company to review their medical program as it concerns 9 hematological issues? 10 A. No. 11 Q. Do you consider yourself to be an occupational 12 physician? 13 A. No. 14 MR. FAULK: Well, I'm going to object 15 to that question as being vague as to what 16 an occupational physician is and move to 17 strike the answer to that. 18 MR. HYDE: I'm almost through with 19 this one. When we finish this, I propose 20 that we take maybe a five-minute break. 21 Would that be agreeable to you? 22 THE WITNESS: Sure. 23 MR. HYDE: And I'll represent to you 24 that I really have about a page or so of 25 notes, and I think it deals more 80 1 specifically with your report. Okay? 2 THE WITNESS: Okay. 3 (By Mr. Hyde) 4 Q. Dr. Natelson, would you ever recommend that a 5 worker wash their hands with benzene? 6 A. No. 7 Q. Would you recommend that a worker wash their 8 tools with benzene? 9 A. No. 10 Q. And you as a hematologist would recognize that 11 as potentially unsafe, correct? 12 A. Yes. 13 Q. Were you provided with Mr. Barrett's 14 deposition? 15 A. I'm sure I was. 16 Q. Did you read 17 A. But if I was, it's in the pile of -- Whatever 18 I've been provided with is right there (indicating). 19 Q. I'm sorry. Dr. Natelson, do you recall reading 20 Mr. Barrett's deposition? 21 A. If I -- if I did, you'll have to jog my memory 22 what specifically I might have read. 23 Q. Do you recall Mr. Barrett discussing the use of 24 benzene to wash hands or tools while he was out at 25 Mobil? 81 1 MR. FAULK: Be sure that you've read 2 the document. 3 A. Yeah. Well, as I say, if the document is in 4 there, I've read it. Now, it may be some weeks ago. 5 And I certainly don't remember that particular 6 statement. 7 Q. Certainly, you would not recommend -- you would 8 not have recommended that Mr. Barrett do that, correct? 9 A. No.. 10 Q. Have you been provided with any depositions of 11 any current or former physicians employed by Mobil? 12 A. No. 13 Q. Has anyone provided you with any information 14 about the level of benzene exposure to pipe fitters at 15 either the Mobil chemical plant O and A facility or the 16 Mobil refinery in Beaumont? 17 A. No. 18 MR. HYDE: Off the record. 19 (AT THIS TIME THERE WAS AN 20 OFF-THE-RECORD DISCUSSION, AFTER WHICH THE 21 PROCEEDINGS RESUMED AS FOLLOWS:) 22 (By Mr. Hyde) 23 Q. Have you ever been provided with any benzene 24 exposure records for millwrights or maintenance 25 mechanics at either the Mobil - Beaumont refinery or 82 1 chemical plant, specifically the 0 and A plant? 2 A. No. 3 Q. Have you been provided with any butadiene 4 exposure monitoring information that concerns the Mobil 5 refinery or Mobil chemical O and A plant? 6 A. No. 7 MR. HYDE: Let's take a break. 8 (AT THIS TIME A BRIEF RECESS WAS 9 TAKEN, AND NATELSON EXHIBIT N0. 11 WAS 10 MARKED FOR IDENTIFICATION PURPOSES AND IS 11 FULLY DESCRIBED IN THE "EXHIBIT INDEX" 12 HEREIN. SAME WILL BE FOUND AT THE 13 CONCLUSION OF THIS DEPOSITION. THE 14 PROCEEDINGS THEREAFTER RESUMED AS FOLLOWS:) 15 (By Mr. Hyde) 16 Q. Doctor, I think this is the letter that Mr. 17 Faulk sent you retaining you as an expert in this 18 litigation. Is that correct? 19 A. Let's just see. Yes. That would appear to be 20 the letter. 21 Q. And with that letter I take it that you got 22 certain medical records. Is that correct? 23 A. Yes. 24 Q. Do you recall specifically which medical 25 records you received? 83 1 MR. FAULK: I think -2 A. I can say that probably about roughly 3 two-thirds came initially. And then I had -- a little 4 bit more came from time to time. There are some other 5 letters in that pile, indicating when some other things 6 came. 7 Q. I'm going to have marked as Exhibit 12 some 8 correspondence from a legal assistant at Mr. Faulk's 9 firm to you, enclosing some additional updated medical 10 records. 11 (AT THIS TIME NATELSON EXHIBIT NO. 12 12 WAS MARKED FOR IDENTIFICATION PURPOSES AND 13 IS FULLY DESCRIBED IN THE "EXHIBIT INDEX" 14 HEREIN. SAME WILL BE FOUND AT THE 15 CONCLUSION OF THIS DEPOSITION.) 16 Q. And you received those medical records sometime 17 around July 9th, 1997, correct? 18 A. Well, the letters and the corresponding 19 documents are a jumble. In other words, this letter 20 doesn't refer to this particular group of documents you 21 have here, I feel certain. I can't tell you which ones 22 came with what. There are numerous letters in there. 23 And because of the way I review them, I don't always 24 keep the form letter: and I don't always put it back in 25 , the same position that it came from. So I can't tell 84 1 you exactly which documents came at which points in 2 time. 3 Q. The fact that the letter, Exhibit 12, was on 4 top of the medical records from St. David's Health Care 5 System, what you're saying is that -6 A. That's meaningless. 7 Q. -- may just be by chance. 8 A. That's correct. 9 Q. Did you make any copies of any of these medical 10 records for your own specific use? 11 A. No. Many of these are duplicates that I was 12 sent at different times. 13 Q. Did you pull out any excerpts from any of the 14 medical records and make copies of those documents? 15 A. No. 16 Q. Do you know why the documents -- I'm going to 17 have this marked 13 based on your testimony then. 18 (AT THIS TIME NATELSON EXHIBIT N0. 13 19 WAS MARKED FOR IDENTIFICATION PURPOSES AND 20 IS FULLY DESCRIBED IN THE "EXHIBIT INDEX" 21 HEREIN. SAME WILL BE FOUND AT THE 22 CONCLUSION OF THIS DEPOSITION.) 23 Q. I've had marked as Exhibit 13 some medical 24 records from the St. David's Health Care System in 25 Austin. And can you tell me approximately when you 85 1 received those documents? 2 A. These 3 MR. FAULK: I don't know if they're 4 not duplicated in some other stack either. 5 A. Well, I'm confident that these documents are 6 duplicated over there in that stack. These documents 7 relate to biopsy reports in general, and they're a 8 collection of biopsy reports from different time 9 periods. And I can't tell you with any certainty when 10 any of that stack came. 11 Q. Did you pull out these specific records? 12 A. Did I? No. 13 Q. Yes, sir. More than likely they were provided 14 to you in this little binder? 15 A. Correct. 16 Q. And do you know who collected the medical 17 records from St. David's Health Care System and bound 18 them together as Exhibit 13? Do you know who did that? 19 A. No. 20 Q. Did you make any writings on any of the 21 documents contained in Exhibit 13? 22 A. I think I may have highlighted something. Let 23 me look at that and see. Yes. I think these yellow 24 highlights are -- that I put on one of these pages are 25 mine. 86 1 Q. Doctor, do you have any evidence that cigarette 2 smoking is a cause of non-Hodgkin's lymphoma? 3 A. No. 4 Q. Doctor, do you have any evidence that radiation 5 exposure is a cause of non-Hodgkin's lymphoma? 6 A. There are articles that say that it is and 7 articles that say that it doesn't. I would have to say 8 that the evidence is slim and equivocal. 9 Q. When you have evidence that is slim and 10 equivocal, does this equate in your mind as something 11 equivalent to a risk factor? 12 A. Well, I ans -- I don't know exactly how to 13 answer that question. 14 Q. Well, and maybe I'm unclear. I want to clear 15 it up. When we say A causes B, then that's very 16 specific, you know, A causes B. Whereas when we say A 17 is a risk factor for B, does that in your mind as a 18 physician mean there may be studies concerning 19 causation; but me, Dr. Natelson -- "I've not come to the 20 I conclusion that, in fact, A causes B: but I will concede 21 that it may be a risk factor that A causes B"? 22 A. I think -- Let me see if I can interpret what 23 you've asked me. For example, if I found that farmers 24 had a high incidence of acute leukemia, I would say -- I 25 might say farming is a risk factor for acute leukemia: 87 1 but it doesn't necessarily mean farming causes leukemia. 2 It might be the chemicals they use. It my be organisms 3 in the soil. It might be viruses they got from their 4 cattle. But it doesn't necessarily mean being a farmer 5 causes the leukemia, but it might be a risk factor. 6 That's my understanding of what you're asking me. 7 Q. Exactly, Doctor. As someone who works with 8 radiation, are they at risk of acquiring non-Hodgkin's 9 lymphoma? 10 MR. FAULK: Object to the question as 11 vague. 12 Q. In other words, in your mind is radiation 13 exposure a risk factor for non-Hodgkin's lymphoma? 14 A. No, not in my mind. 15 (AT THIS TIME THERE WAS AN 16 OFF-THE-RECORD DISCUSSION BETWEEN MR. HYDE 17 AND MR. WIMBERLEY, AFTER WHICH THE 18 PROCEEDINGS RESUMED AS FOLLOWS:) 19 MR. HYDE: Off the record. 20 (AT THIS TIME THERE WAS AN 21 OFF-THE-RECORD DISCUSSION, AFTER WHICH THE 22 PROCEEDINGS RESUMED AS FOLLOWS:) 23 MR. HYDE: Back on the record. 24 (By Mr. Hyde) 25 Q. Do you know of any genetic risk factors 88 1 concerning the causation of non-Hodgkin's lymphoma? 2 A. Yes.. There are risk factors in the causation 3 of non-Hodgkin's lymphoma that are genetic in that we 4 see that illness occasionally in multiple family 5 members. Now, what the specific defect is is uncertain 6 but it clearly is a genetic defect because we see it in 7 multiple -- maybe in siblings or father-daughter. And 8 there's enough of a pattern to say that there clearly is 9 a genetic influence. But specifically what the gene is 10 or what the defect is, we don't know. 11 We also see circumstances where there are 12 inherited diseases of the immune system where the 13 immunity is extremely reduced. And in these 14 circumstances a person may catch lymphoma; and, again, 15 we don't know if they caught the lymphoma because they 16 were so immunosuppressed that they couldn't handle a 17 particular virus or whether or not it was something the 18 matter with their DNA, let's say, that was innate and 19 related to the immune defect. But the bottom line is we 20 do recognize circumstances in which there are genetic 21 patterns to lymphoma. 22 Q. Is there any genetic pattern or risk factor 23 specifically concerning Mr. Lester Barrett and his 24 non-Hodgkin's lymphoma? 25 A. Well, in the information that I have, I don't 89 1 have information that other people in his family have 2 lymphoma. 3 Q. So as we sit here today, you have no evidence 4 that Mr. Barrett, because of his genetic background, was 5 at increased risk of acquiring non-Hodgkin's lymphoma: 6 is that true? 7 MR. FAULK: One moment. That 8 mischaracterizes his testimony. His. 9 testimony 10 MR. HYDE: Well, let him 11 MR. FAULK: -- was very specific. 12 MR. HYDE: Let him answer. 13 MR. FAULK: Well, I don't want you 14 MR. HYDE: Just state your objection. 15 MR. FAULK: -- to mis 16 MR. HYDE: And I'd prefer that you 17 not 18 MR. FAULK: Well, I just did. 19 MR. HYDE: Fine. 20 (By Mr. Hyde) 21 Q. Would you answer the question? 22 A. Run the question by again exactly. 23 MR. HYDE: Ms. Court Reporter -- And I 24 know Mr. Faulk 25 THE WITNESS: Maybe she can read the 90 1 question. 2 MR. HYDE: -- has an objection. Go 3 ahead and put the objection when you read 4 it back. 5 MR. FAULK: The objection is that the 6 question mischaracterizes his testimony. 7 (AT THIS TIME THE REQUESTED MATERIAL 8 WAS READ BACK.) 9 A. Is there any risk factor in his family? Is 10 that what you're asking? Not that I'm aware of. 11 (By Mr. Hyde) 12 Q. And I don't want to repeat myself, but I'm 13 going down this outline here, so I'm going to just go 14 down. Have you seen any opinions from anyone concerning 15 the level of exposure that Mr. Lester Barrett had to 16 benzene? 17 A. I don't recall seeing that. 18 Q. Have you seen any epidemiological studies 19 concerning the use of solvents and an increased SMR or 20 odds ratio or relative risk concerning non-Hodgkin's 21 lymphoma? 22 MR. FAULK: I object. The question's 23 vague without a definition of solvents. 24 A. I've seen -- I may have. I've seen summaries 25 of such studies that suggest an increased risk of 91 1 non-Hodgkin's lymphoma. 2 Q. Doctor, do you recognize the possibility that 3 benzene may cause non-Hodgkin's lymphoma? 4 A. In my opinion there's no evidence that we have 5 today in 1997 that benzene causes non-Hodgkin's 6 lymphoma. And so with that in mind, I would have to say 7 there's no reason for me to think that benzene caused 8 this man's lymphoma. 9 MR. HYDE: Let me object. 10 (By Mr. Hyde) 11 Q. My question was kind of specific, though broad 12 in some ways. Do you, Dr. Natelson, believe that it is 13 possible -- and not probable but just there's some 14 possibility that benzene may cause non-Hodgkin's 15 lymphoma? 16 MR. FAULK: I object. The question's 17 vague because non-Hodgkin's lymphoma is not 18 sufficiently specific for him to answer. 19 Q. You may answer, Doctor. 20 A. I don't have any reason to think that benzene 21 causes non-Hodgkin's lymphoma.. 22 Q. well, we have gone over the Chinese study 23 A. Yes. 24 Q. -- where there was an SMR of 4.1 for workers 25 exposed to benzene over ten years and the formation of 92 1 non-Hodgkin's lymphoma. We've gone over the Mobil 2 epidemiologic study and discusset specifically 3 non-Hodgkin's lymphoma amongst maintenance workers where 4 there was a 68 percent increase, though not 5 statistically significant but still an SMR of 168. And 6 you're aware of other studies concerning SMRs that are 7 elevated for non-Hodgkin's lymphoma amongst workers 8 exposed to either solvents or benzene, correct? 9 A. Yes. 10 Q. And my question is not whether you assign 11 benzene as a cause of non-Hodgkin's lymphoma. My 12 question is: Do you recognize that benzene is a 13 potential risk factor for non-Hodgkin's lymphoma? 14 MR. FAULK: I object to the question 15 as being vague, indefinite, and 16 misleading 17 COURT REPORTER: I'm sorry. I need 18 you to speak up. 19 MR. FAULK: I'm sorry. I object to 20 the question as vague, indefinite, and 21 misleading because the category 22 non-Hodgkin's lymphoma is not a disease. 23 A. Well, my answer is that there are papers in the 24 literature, as you've pointed out, that suggest that 25 benzene is a risk factor. But when you look on balance 93 1 in all of the information, I do not believe that benzene 2 causes non-Hodgkin's lymphoma. 3 Q. And do you think that it's even a possible 4 cause? 5 MR. FAULK: I'll object. The 6 question's asked and answered. 7 A. Well, I don't -- I don't -- I don't see that it 8 would be a possible cause. 9 Q. Do you agree that there is a need for 10 additional study with respect to benzene and whether or 11 not benzene exposure is associated -- or a cause of 12 non-Hodgkin's lymphoma? 13 MR. FAULK: Again object to the vague 14 category non-Hodgkin's lymphoma. 15 A. Well, I think that basically the benzene issue 16 is chasing your tail. In other words, you have a 17 situation where benzene exposure is going down and has 18 been going down for many years, where the diseases that 19 we associate with benzene, such as aplastic anemia and 20 acute leukemia, are virtually nonexistent. And you have 21 a situation where lymphoma is increasing -- despite this 22 the lymphoma is going the opposite direction and 23 increasing. So to me if someone wants to put energy 24 into epidemiologic studies, it's not to worry about 25 whether benzene causes non-Hodgkin's lymphoma but to 94 1 look at other things. I think the benzene question has 2 been answered. 3 MR. HYDE: I probably need to object 4 to responsiveness. 5 THE WITNESS: All right. 6 (By Mr Hyde) 7 Q. Do you have any evidence as to the diet that 8 Mr. Barrett had prior to his diagnosis 9 A. No. 10 Q. -- of non-Hodgkin's lymphoma? 11 A. No. 12 Q. Do you know whether Mr. Barrett had anything 13 but an average intake of salt? 14 A. I have no idea what his salt intake was. 15 Q. Did you see any evidence that Mr. Lester 16 Barrett had a history of gastritis? 17 A. Well, he had dyspepsia, which certainly could 18 be gastritis. I believe that led to a gallbladder 19 operation. Isn't that right? I'd have to look again at 20 my comments, if we have them, about his history. 21 Q. They're here somewhere, Doctor. 22 MR. FAULK: Well, that's -- If you 23 need to review it, let's -24 MR. HYDE: Yeah. 25 MR. FAULK: -- just pull it out. It 95 1 can be 2 A. Let's just look and find that letter and see 3 just what I said about his history. 4 MR. FAULK: I think it's the second 5 exhibit. 6 Q. Take your time, Doctor. 7 A. Yes. In other words, he had a laparoscopic 8 cholecystectomy because of abdominal symptoms; and 9 gastritis may or may not produce abdominal symptoms. 10 Some people have a lot of abdominal symptoms from severe 11 gastritis. In other people it's almost an asymptomatic 12 condition. But he had the potential to have symptoms 13 from it because someone thought enough of his abdominal 14 pain to take out his gallbladder. 15 MR. HYDE: I'm sorry. I need to 16 object to the responsiveness. 17 (By Mr. Hyde) 18 Q. Have you seen any document in the medical 19 records that states Mr. Barrett had a history of 20 gastritis -21 MR. FAULK: I'm going to object 22 because I think 23 Q. -- that specific diagnosis? 24 MR. FAULK: Okay. I'm going to 25 object. I think the question is vague 96 1 because you're not -- the question 2 doesn't -- Are you talking about the 3 history? Are you talking about any 4 document, including biopsies, gastrectomy, 5 or anything like that? 6 MR. HYDE: Any document. 7 A. Yes. 8 (By Mr. Hyde) 9 Q. Other than your report. 10 A. Yes. Certainly, he's -- we have here somewhere 11 these various biopsy reports. And I believe his initial 12 biopsy report showed inflammation in the stomach. 13 Q. Okay. Would you show me those? I think 14 they're in front of you. 15 A. Let's find that someplace. Let's see what 16 we've got here. Let's just see. 17 Q. And what I'm looking for is a document that 18 shows a history of gastritis. 19 A. Okay. Well, in the -- even the biopsy 20 that -- from the surgery -- Let's see where we are here. 21 This is a biopsy done on 8/11/94, where we talk about 22 background of inflammatory cells such as eosinophils and 23 neutrophils. We have a background of inflammation in 24 this biopsy. Now, that's not a history. In other 25 words, a history is something you take from the patient. 97 1 This is a pathologic diagnosis. 2 Q. And that's the point I was trying to get to, 3 Doctor. Have you seen any document concerning Mr. 4 Barrett that states that Mr. Barrett had a history of 5 gastritis? 6 A. No. 7 Q. Have you seen any document or any evidence to 8 indicate that Mr. Barrett had a history of any type 9 ulcer? 10 A. No. 11 Q. Did you personally review any of the pathology 12 slides concerning any of the biopsies taken from Mr. 13 Barrett? 14 A. No. 15 Q. Are you a pathologist? 16 A. No. 17 Q. Obviously you're aware of the treatment that 18 Mr. Barrett received for his lymphoma, correct? 19 A. Yes. 20 Q. And would you briefly describe the treatment 21 that Mr. Barrett received for his lymphoma? 22 A. Well, his initial treatment was with 23 chemotherapy with what's called the CHOP protocol, which 24 is probably the most widely used group of drugs for 25 large cell lymphoma in the -- in the country. And he 98 1 had several courses of this type of CHOP chemotherapy 2 C-H-O-P chemotherapy. And when there was no evidence 3 that he had had a major favorable response, he 4 subsequently underwent surgery and had removal of the 5 stomach -- or part -- part of it. 6 Q. Do you have any criticisms of the treatment 7 that Mr. Barrett received for his lymphoma? 8 A. No, in that CHOP chemotherapy is a standard 9 form of chemotherapy for non-Hodgkin's lymphomas. 10 Q. Now, one of the risks associated with 11 chemotherapy is the risk of a future leukemia, correct? 12 A. Yes. That would be true. 13 Q. And based on any epidemiological studies you've 14 seen, persons who receive chemotherapy are at an 15 increased risk of acquiring leukemia. 16 A. Well, as a generic statement, that wouldn't be 17 true. It depends on the type of chemotherapy, the doses 18 they get, the duration. But depending on -- If you want 19 high doses of therapy, as one might give in the CHOP 20 protocol, the answer would be yes 21 Q. In other words, because of the CHOP 22 chemotherapy that Mr. Barrett received, he's now at an 23 increased risk of a future leukemia, correct? 24 A. Yes. That would be so. 25 Q. And that's confirmed by valid epidemiological 99 1 studies: is that correct? 2 A. Yes. 3 Q. What is your understanding as it concerns Mr. 4 Barrett's prognosis? 5 A. Well, his prognosis -- I guess at this point 6 one would have to consider it to be uncertain because 7 lymphomas are very unpredictable. And at the moment 8 things look very good for him. He's gone some years 9 now, three years I take it, sense the surgery. And, 10 generally speaking, in large cell lymphomas, if you make 11 it past three years, you usually do very well from the 12 standpoint of reoccurrence. However, lymphomas that 13 involve the gastrointestinal tract tend to carry a 14 somewhat worse prognosis. And I would say he's probably 15 not totally out of the woods. 16 Q. So based on your experience, someone who 17 has -- someone like Mr. Barrett with his lymphoma, 18 they're at risk of having a subsequent lymphoma, 19 correct -- or subsequent tumors? 20 A. He may have a relapse. 21 Q. Relapse. And that -- In your mind that would 22 obviously be a very serious and potentially 23 life-threatening condition, correct? 2 4 A. Yes. 25 Q. In a general sense, the lymphoma that Mr. 100 1 Barrett had was a life-threatening cancer, correct? 2 A. Correct. 3 Q. And I take it that in your practice you have 4 seen patients die of the type of lymphoma that Mr. 5 Barrett has, true? 6 A. Well, yes. I would say that would be true. 7 Q. Therefore, you -- as a physician you recognize 8 the stress that Mr. Barrett was under when he received 9 his diagnosis and his treatment, correct? 10 A. I would assume that would be very stressful for 11 most people. 12 Q. And you also understand that it would be a very 13 painful condition, correct, that requires the 14 administration of certain pain medicine? 15 A. Well, the surgery would be associated with some 16 pain. Now, the chemotherapy is not particularly a 17 painful process -- taking chemotherapy. 18 Q. But the ill effects from chemotherapy can be 19 very painful, correct? 20 A. I wouldn't use the term "painful." They might 21 be unpleasant. Your hair might fall out. But that's 22 not painful. It might be psychologically painful, but 23 it doesn't hurt. It depends -- You might get -- get a 24 little nausea, but that's very minimal these days. You 25 might get, low blood counts, but that doesn't cause pain. 101 1 So pain is probably not the right word to use. 2 Q. Well, during the time period when Mr. Barrett 3 was receiving treatment for his lymphoma, do you know 4 what pain medicine was prescribed to Mr. Barrett? 5 A. I don't recall. 6 Q. Certainly morphine is not given to all your 7 patients, correct? 8 A. It's certainly not, no. 9 Q. And typically when a doctor prescribes morphine 10 to a patient, that is because the patient has reported 11 significant pain. 12 A. Yes. 13 Q. And as we sit here today, that's just not an 14 area of Mr. Barrett's medical records that you've 15 reviewed with an eye on the details, correct? 16 A. That would be correct, yes. 17 Q. And certainly in your work as a hematologist, 18 you've seen the effect on the spouses and family members 19 when the patient has been told of a diagnosis of 20 lymphoma and undergoes the treatment, correct 21 A. Yes. 22 Q. And that is in your mind a very stressful time 23 period for the family. 24 A. Certainly can be, yes. 25 Q. I'm sorry. Where is your report, Doctor? Let 102 1 me see if I can find mine real quick. I've got mine so 2 let me give you yours. And we're looking at Exhibit 2, 3 your report in this matter; is that correct? 4 A. Yes. 5 Q. Have you seen any other reports other than 6 Exhibit 2 as it relates to this case? 7 A. No. 8 MR. FAULK: Where did you get that? 9 That's what he sent to you -- his report? 10 MR. HYDE: Actually, we got it in Otto 11 Wong's deposition. 12 MR. FAULK: Oh, okay. Okay. I was 13 just curious. 14 (By Mr. Hyde) 15 Q. Doctor, are you a board certified oncologist? 16 A. I'm a board certified hematologist. 17 Q. Are you a board certified oncologist? 18 A. No. Hematologists do oncology but there -- The 19 division of oncology occurred after my training. 20 Q. Okay. 21 A. In other words, there wasn't such an entity at 22 the time I was trained. 23 Q. I understand that. In May of 1993, Mr. Barrett 24 had his gallbladder removed, correct? 25 A. Yes. 103 1 Q. Anything abnormal about that in your mind? 2 A. No. 3 Q. Mr. Barrett then later in August of 1994 had a 4 workup, including gastroscopy -5 A. Uh-huh. 6 Q. -- and gastric biopsy: is that correct? 7 A. Correct. 8 Q. What are those, Doctor? 9 A. Well, gastroscopy is looking inside the stomach 10 with a flexible lighted tube. 11 Q. And that's usually done on an outpatient basis: 12 is that correct? 13 A. Typically, yes. 14 Q. Additionally, he had -- Mr. Barrett, that is, 15 in August of 1994 had a gastric biopsy. 16 A. Yes. 17 Q. And I take it that's when some tissue was 18 removed during the gastroscopy, correct? 19 A. Yes. 20 Q. And there's some device that allows you to 21 remove tissue? 22 A. Correct. 23 Q. And from what exact organ was this tissue 24 removed? 25 A. From various parts of the stomach. 104 1 Q. In your mind is gastric carcinoma and gastric 2 lymphoma the same thing? 3 A. No, definitely not. 4 Q. Totally different cancers, correct? 5 A. Well, they're totally different cancers. Now, 6 they may occur in the same individual; but they're 7 totally different cancers. 8 Q. And in August of 1994, Mr. Barrett received the 9 unpleasant diagnosis of lymphoma, correct? 10 A. Correct. 11 Q. And from August of 1994 through November of 12 1994, Mr. Barrett received the chemotherapy or the CHOP. 13 A. Yes, chemotherapy. 14 Q. In November Mr. Barrett continued to have 15 lymphoma in his stomach area, correct? 16 A. Yes. 17 Q. And on December 8th, 1994, Mr. Barrett 18 underwent a gastric resection; is that correct? 19 A. Correct. 20 Q. Would you explain to the judge and jury what a 21 gastric resection is? 22 A. Well, the stomach is a large organ; and there 23 are names for various parts of it. And a gastric 24 resection is where part of the stomach is removed. It 25 may vary from a small part to a large part. But 105 1 resection means a part is removed, and then the remnant 2 is hooked back together. 3 Q. And, of course, when an individual receives a 4 gastric resection, there are many future problems that 5 that individual will likely have associated with that 6 resection, correct 7 A. As a general rule, that's true. 8 Q. And what are some of those problems that 9 someone would have when receiving a resection of their 10 stomach 11 A. Well 12 Q. -- or removal of part of their stomach? 13 A. Probably the most common would be a failure to 14 gain weight or have difficulty in gaining weight because 15 part of the absorptive surface is gone. Now, there are 16 many other potential complications. In part they depend' 17 on what sort of a reconstruction is done. Depending on 18 the type of reconstruction, a person may have what's 19 called a dumping syndrome, where they get episodes of 20 abdominal pain and sudden diarrhea. They may get 21 bleeding complications from the anastomosis lines or 22 where the stomach was put back together. They may get 23 loss of vitamin B12 absorption and have to get some 24 vitamin B12.shots. Those are some of the things that 25 come to mind. 106 1 Q. Also, when a person like Mr. Barrett receives 2 his resection or removal of part of his stomach, that 3 has some effect on the stomach acids, correct? 4 A. Well, depending on what part is removed. 5 The -- the higher part of the stomach has most of the 6 acid-forming glands in there, and the lower part of the 7 stomach has some of the more enzyme-producing cells. So 8 it depends on what -- actually what part is taken out. 9 Q. one effect of having your stomach -- part of 10 your stomach removed is that you may be subject to 11 infection at a higher rate than someone who has not gone 12 through this procedure, correct? 13 A. Certain types of infections it's thought 14 that -- At least in the older literature, it was thought 15 that tuberculosis can occur in a higher incidence in 16 people who have had part of their stomach removed. 17 Certain kinds of infections are present at higher rates. 18 Q. And that's even with someone who didn't have a 19 history of tuberculosis, correct? 20 A. That would be correct, yes. 21 Q. Now, the dumping syndrome that you talked 22 about, that is something that would result in someone 23 having diarrhea because of the smaller stomach, correct? 24 A. Well, it's not because of the smallness of the 25 stomach. But generally stomachs are put back together 107 1 by what used to be called either a Billroth I or a 2 Billroth II type procedure. In the Billroth I 3 procedure, everything looks the same except the stomach 4 is just a little smaller. And that doesn't have a lot 5 of dumping associated with it. In the Billroth II 6 operation, you have what's referred to as a blind loop. 7 You have a piece of intestine sort of floating in the 8 breeze with the bile ducts connected to it. And that 9 intestine can suddenly fill up with liquids and kink and 10 create problems. And I must say I've forgotten what 11 type of resection he had as to what his hookup was. But 12 in part it depends on how the reconstruction is done. 13 Q. Mr. Barrett -- Have you seen any evidence that 14 he had problems with diarrhea and as such was required 15 to wear a diaper? 16 A. I don't recall seeing that. 17 Q. Certainly, that's something you've heard about, 18 individuals who have had stomach resections -- that they 19 may need to wear diapers because of this dumping 20 syndrome, correct? 21 A. Well, that would be very unusual. I suppose 22 it's possible; but that certainly wouldn't be the rule. 23 Q. Now, to save myself the embarrassment of having 24 to say this name over and over and over, I'm going to 25 try to say it one time: and then I'm going to try to do 108 1 a little abbreviation. But Helicobacter pylori 2 A. Uh-huh. 3 Q. -- is what? 4 A. Helicobacter pylori is a bacteria that may live 5 in the stomach and colonize the stomach. And it's been 6 associated with a number of problems because of that. 7 In recent years it's been recognized that ulcer 8 disease -- peptic ulcer disease is a common consequence 9 of that infection. One can also have chronic gastritis 10 or inflammation of the stomach as a result of that 11 infection, which may or may not produce any symptoms. 12 In recent years it's been recognized that that organism 13 can stimulate the transformation of lymphocytes from 14 normal lymphocytes into lymphomatous lymphocytes. And 15 we call this a MALT lymphoma. 16 COURT REPORTER: A what? 17 THE WITNESS: A MALT, M-A-L-T, 18 lymphoma. 19 A. And it's also been thought to -- The chronic 20 inflammation that may result has also been thought to 21 cause gastric carcinoma, which is a different type of 22 tumor of the stomach. It's an organism that is 23 sensitive to many antibiotics, but sometimes it's 24 difficult to eradicate. 25 Q. What percentage of the males 'in the 50 age 10 9 1 category in the United States have H. pylori in their 2 stomach? 3 A. I don't know the exact number. 4 Q. Do you know whether we're talking 5 about -- Well, let's talk in general. Of the male 6 population in the United States for adult males, what 7 percentage of that population has H. pylori in their 8 stomach? 9 A. I don't know the number. I mean, it's a 10 significant number. It's not a rare finding. ,But 11 certainly not everybody has it. 12 Q. Are we talking millions of males in the United 13 States who have H. pylori in their stomach? 14 A. Well, I -- As I say, I don't know the exact 15 figures: but it could be as much as 10 to 15 percent, 16 which would translate to a lot of people. 17 Q. Is there anyplace in particular where you have 18 gotten that number that maybe 10 to 15 percent of the 19 males in the United States may have H. pylori in their 20 stomach? 21 A. No. I took it you asked me to speculate. 22 These numbers are in the GI literature. They vary all 23 over the world, depending on where you live. You said 24 the United States. 25 Q. Yes, sir. 110 1 A. And so I may subliminally have seen a number 2 like that in one of these articles. But I wouldn't 3 refuse to be held to a specific number because I don't 4 know it. 5 Q. You're giving me your best recollection 6 A. I'm just giving you a guess. 7 Q. Are there different types of H. pylori, 8 different strains? 9 A. There are different strains of the bacteria, 10 yes. 11 Q. What specific strain of H. pylori do you 12 contend that Mr. Barrett had? 13 A. I don't know what strain he had. 14 Q. Do you know when -- at what point in time Mr. 15 Barrett was, if ever, infected with H. pylori? 16 A. Well, the gastric resection biopsy demonstrated 17 evidence of chronic inflammation with plasma cells and 18 other inflammatory cells, suggesting that it had been 19 present there at least months, possibly longer. But the 20 exact time would be unknown. 21 MR. HYDE: I need to object to the 22 responsiveness. 23 (By Mr. Hyde) 24 Q. My question was: Do you know or have any 25 evidence specifically as to when Mr. Barrett was first 111 1 infected with H. pylori? 2 A. No. 3 Q. Have you reviewed any literature in scientific 4 or medical journals concerning the ways in which someone) 5 can be infected with H. pylori? 6 A. Well, it's generally considered to be the oral 7 route. In other words, one of the describers of the 8 illness gave it to himself by -- by swallowing the 9 bacteria. 10 Q. That's one way. 11 A. Yeah. I mean, certainly that would be 12 the -- the way one would expect to get it is some type 13 of oral contamination. 14 Q. Have you read any published literature 15 concerning the risk of infecting a person with H. pylori 16 through gastroscopy? 17 A. Gastroscopy, yes. Many infections have been 18 introduced, from tuberculosis to a number of things, 19 through improperly sterilized equipment. And generally 20 the gastroscopy devices are gas sterilized. But if they 21 weren't sterile, it might be passed from one person to 22 another. 23 Q. You certainly recognize that gastroscopy is a 24 risk factor concerning the infection from H. pylori? 25 A. Well, a risk factor with dirty equipment. I 112 1 mean, I don't think it's a risk factor inherent to being 2 gastroscoped. It depends on whether the equipment is 3 sterile or not sterile. 4 Q. Are you aware of any cases of H. pylori 5 infections from gastroscopy? 6 A. Gastroscopy? 7 Q. Yes. 8 A. I can't cite a particular article, but I'm 9 quite certain that that's occurred. I'm sure I've seen 10 that in the literature. 11 Q. Have you seen any -- Well, strike that. Have 12 you seen instances of contamination of a gastroscope 13 here at St. Joseph's Hospital? 14 A. No. 15 Q. Would that be something that you would know 16 about? 17 A. Probably, almost certainly. 18 Q. A copy for you and a copy for me. 19 MR. HYDE: Mark in that order. 20 (AT THIS TIME NATELSON EXHIBIT NOS. 14 21 AND 15 WERE MARKED FOR IDENTIFICATION 22 PURPOSES AND ARE FULLY DESCRIBED IN THE 23 "EXHIBIT INDEX" HEREIN. SAME WILL BE FOUND 24 AT THE CONCLUSION OF THIS DEPOSITION.) 25 (By Mr. Hyde) 113 1 Q. Doctor, on Exhibit 13 you had some specific 2 medical records concerning biopsies? 3 A. Yes. 4 Q. And I've had marked as Exhibits 14 and 15 some 5 additional medical records which, I think, concern the 6 same subject. 7 A. All right. 8 Q. So I think between Exhibits 13, 14, and 15, all 9 of the biopsies associated with Mr. Barrett's stomach 10 should be included in those three exhibits. I'll give 11 you a chance to look at it and see if you know of any 12 others -- any other studies concerning biopsies of Mr. 13 Barrett's stomach. Take your time. 14 A. Well, this first one has two sets of biopsies 15 in here, it looks like. This one is from 11/1/94, and 16 then there's a second one that's from 1/6/95. 17 Q. Now, let's see 18 A. Okay. 19 Q. Those are some biopsies 20 A. Okay. 21 Q. -- of Mr. Barrett. And then you had some more 22 in your stack under Exhibit 13, correct? 23 A. Let's see. Where is -- Yes. 24 Q. Okay. Why don't you read the dates on those 25 biopsies, please? 114 1 A. All right. Okay. Let's see. First one we 2 have here is 8/11/94. 3 Q. That's a biopsy of Mr. Barrett's stomach, 4 correct? 5 A. Right. 6 Q. What's the next one? 7 A. The next one is same as this, I guess, 11/1/94. 8 Q. All rightie. 9 A. And then we've got 12/8/94. 10 Q. 12/8/94. All right. Any others? 11 A. We've got 1/4/95. We've got 2/6/96. 12 Q. Okay. Any more? 13 A. That looks to be it. 14 MR. FAULK: There's another exhibit. 15 A. Yeah. There's another exhibit. Let's see 16 if 17 Q. Yeah. Go ahead and do that. 18 A. This may be a duplication. 19 Q. Yeah. There may be -- may be some duplication 20 there, so we want to make sure that we've got all this 21 down. 22 A. Here's one from 2/6/96. I think we had that 23 one. 24 Q. I think we had that one, yes. 25 A. I think that's it. 115 1 (AT THIS TIME THERE WAS AN 2 OFF-THE-RECORD DISCUSSION, AFTER WHICH THE 3 PROCEEDINGS RESUMED AS FOLLOWS:) 4 (By Mr. Hyde) 5 Q. Okay, Doctor. I have 6 MR. HYDE: Go ahead and mark that as 7 the next exhibit. 8 (AT THIS TIME NATELSON EXHIBIT NO. 16 9 WAS MARKED FOR IDENTIFICATION PURPOSES AND 10 IS FULLY DESCRIBED IN THE "EXHIBIT INDEX" 11 HEREIN. SAME WILL BE FOUND AT THE 12 CONCLUSION OF THIS DEPOSITION.) 13 (By Mr. Hyde) 14 Q. Now, I've had marked as Exhibit 16 a piece of 15 paper that I have entitled, "Lester Barrett Stomach 16 Biopsies." And I've listed six dates, that being August 17 11th, 1994; November 1st, 1994; December 8th, 1994; 18 January 4th, 1995; January 6, 1995; and February 6th, 19 1996. And it's my understanding that as it relates to 20 the medical records, those are the biopsies -- the dates 21 of the biopsies from Mr. Barrett's stomach. Is that 22 A. Yes. That seems to be correct here. 23 MR. FAULK: I'm going to object to the 24 use of this document in the format that 25 you've prepared it because by referring to 116 1 them generally as the subject of biopsies, 2 they're not sufficiently specific to 3 describe the types of biopsies involved. 4 And I'll object that it's misleading in 5 that regard. 6 Q. Doctor, would you get Exhibits 13, 14, and 15 7 out 8 A. Okay (complying.) 9 Q. -- and find specifically the biopsy work 10 performed on Mr. Barrett on August 11th, 1994? Are we 11 there? 12 A. Yes, we're there. 13 Q. How many samples were collected on Mr. 14 Barrett -- Mr. Barrett's stomach on August 11th, 1994? 15 A. Five irregular tan soft tissue fragments. 16 Q. So five biopsies? 17 A. Yes. 18 Q. Five biopsies we're taken on August 11th, 1994; 19 is that correct? 20 A. Yes. 21 Q. Were there any more? 22 A. On that date? It just said received in 23 formalin are five biopsies from that session. 24 Q. What were the results of those five biopsies as 25 it concerns H. pylori and the presence or absence of H. 117 1 pylori? 2 A. H. pylori was not seen in these biopsies. 3 Q. I'll put over here, "No H. P." Now, would you 4 turn with me in the medical records to the biopsies 5 taken of Mr. Barrett on November 1st, 1994? 6 A. 11/1/94. Is that what we're after? Yes. 7 Q. Yes, sir. How many biopsies were taken of Mr. 8 Barrett on November 1st, 1994? And I'm talking about 9 biopsies in Mr. Barrett's stomach. 10 A. Seven biopsies. 11 Q. Now, of the seven biopsies taken of Mr. Lester 12 Barrett's stomach on November 1st, 1994, how many of 13 those biopsies showed the presence of H. pylori? 14 A. H. pylori is not identified. 15 Q. I've put under there next to those biopsies on 16 my Exhibit 16, "No H. P.," meaning no H. pylori, 17 correct? 18 A. Correct. 19 Q. Now, the next sample was taken December 8th, 20 1994; is that correct? 21 A. Correct. 22 Q. And how many biopsies were collected from Mr. 23 Barrett's stomach on December 8th, 1994? 24 A. Well, the part of the stomach was removed;-and 25 they -- The pathologist did the biopsy on this occasion 118 1 by removing part of the stomach to look at it. And he 2 lists -- He or she lists this as A & B, C, D, E, F, G, 3 H, I, J. SO that's 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, and a 4 - K, 11. So he has at least 11 sections here that they're 5 looking at. 6 Q. So would it be correct to say that there were 7 11 biopsies taken of Mr. Barrett's stomach, the portion 8 that was removed, and examined December 8th, 1994? Is 9 that correct? 10 A. Well, there were -- You know, culling these 11 biopsies, they're really apples and oranges. These are 12 not exactly biopsies. They're hunks of the stomach that 13 the person's putting under the microscope. They're not 14 really biopsies. 15 Q. Okay. 16 A. They're separate slides that are being 17 prepared. 18 Q. Why don't I put on December 8th, 1994, instead 19 of putting biopsies, then part of stomach. 20 A: You could put part of stomach, yes. 21 Q. Part of stomach. 22 MR. FAULK: Or more correctly, 23 -parts 24 A. Parts of stomach. 25 Q. Parts of stomach. 119 1 MR. FAULK: -- 11 parts. 2 Q. Now, as it relates to the testing on December 3 8th, 1994, was H. pylori found according to the 4 pathologist? 5 A. Helicobacter-like organisms identified, reads 6 the report. 7 Q. Now, it says H. pylori-like organisms, correct? 8 A. Correct. 9 Q. Do you have any idea what strain of H. pylori? 10 A. No. 11 Q. Prior to December 8th, 1994, is there any 12 medical record concerning Mr. Lester Barrett that 13 suggests by pathology the presence of H. pylori in Mr. 14 Barrett's stomach? 15 A. Now, prior to which date, did you 16 Q. Fair enough. So we can get clear, prior to 17 December 8th, 1994, is there pathology that specifically 18 states that Mr. Barrett has H. pylori in his stomach? 19 A. No. 20 Q. So on December 8th, 1994, for the parts of the 21 stomach that were examined, H. P.-like organisms were 22 found. 23 A. Correct. 24 Q. Let me put that in there. "H. P.-like 25 , organisms found." Now, would you turn with me to the 120 1 January 4th, 1995,-biopsies? 2 A. Let's see. Which-- January 4, 1995, correct. 3 Q. How many biopsies were collected on January 4 4th, 1995? 5 MR. FAULK: Let me stop you just a 6 minute. I'm going to object to the way 7 that -- Well, I'll wait until you finish 8 with your chart. It's misleading because 9 you didn't put the number of parts of the 10 stomach that were listed and you did with 11 respect to the other biopsies. 12 A. Here the numbers are not identified. It just 13 says multiple. 14 Q. What does it say, sir? 15 A. It says multiple. 16 Q. Multiple what? 17 A. Soft pale tan tissue fragments. 18 Q. Multiple -- And I'm just going to put M-u-1-t. 19 Multiple what? 20 A. Soft pale tan tissue fragments, which range in 21 size from minute up to 3 millimeters. 22 Q. Mult -- You've got to slow down here. Multiple 23 soft 24 A. "Received in formalin labeled "fundus" are 25 multiple soft pale -- 121 1 Q. Pale. 2 A. -- tan 3 Q. Pale as in p-a-1-e? 4 A. P-a-1-e, pale 5 Q. -- slash, tan? 6 A. -- tan tissue fragments 7 Q. Tissue fragments? 8 A. -- which range in size from minute up to 3 9 millimeters." 10 Q. And we don't know how many multiple 11 A. No. 12 Q. -- soft pale tan tissue fragments; is that 13 correct? 14 A. Correct. 15 Q. And what was found by the pathologist 16 concerning H. pylori from those samples? 17 A. H. pylori was not commented upon. 18 Q. "No comment," I'm going to put, "re: H. P." 19 Now, on January 6th, 1995, what type of biopsies were 20 taken? 21 A. 195 or 196? 22 Q. I'm sorry. January -- January 6th, 1995, I 23 thought we also had a sample somewhere amongst these 24 records. 25 A. You could be right. Let's see. 122 1 Q. Yeah. It might be in the records that I have 2 there, Doctor. 3 A. Okay. We've got a January 4, '95 that we've 4 gone over. Okay. 5 Q. And what is the date of that document? Can you 6 tell? 7 A. January 4. 8 Q. Okay. 9 A. That's when it was dictated. 10 Q. Okay. The January 6th? 11 A. Yeah. 12 Q. Okay. So -13 A. I think we're talking about the same -- you've 14 got the same thing. It was done on -- His procedure was 15 done on the 4th but typed on the 6th. 16 Q. Here we go. I'm going to put this 17 little -- join together those two samples as being 18 really one. 19 A. Okay. 20 Q. Okay. Now, let's go to the February 6th, 1996, 21 biopsy work. Do you see that? 22 A. Yes. 23 Q. How many biopsies were taken February 6th, 24 1996? 25 A. Five. 123 1 Q. And what was mentioned on February 6th, 1996, 2 from the five biopsies concerning H. pylori? 3 A. That's not commented on. 4 Q. Let me put that in there. "No comment re: H. 5 P." Turn back please, Doctor, to the December 8th, 6 1994, biopsy work. 7 A. December 4. December 8, '94? 8 Q. Oh, I'm sorry. December 8th, 1994. 9 A. Yes. 10 Q. May I see that report for one second? I mean, 11 I know I've seen it. I just want -- Doctor, you 12 indicated that there were 11 slides or 11 parts of the 13 stomach that were biopsied or samples collected on 14 December 8th, 1994; is that correct? 15 A. Yes. 16 Q. How many of those slides or parts of the 17 stomach for Mr. Barrett were found to have H. 18 pylori-like organisms? 19 A. Well, I don't know from his report. In other 20 words, he -- he's talking about B, which is one of them 21 and that's when he mentions it. And he doesn't mention 22 it again. 23 Q. So as we sit here today, looking at the medical 24 records, the pathology from December 8th, 1994, H. 25 P. -like organisms were found and attributed to one slide 124 1 based on the report based on its literal reading, 2 correct? 3 A. Well, he mentions it under category B, in the 4 proximal shave margin. 5 Q. And 6 A. Now, whether it was in other reports, other 7 areas, I don't know. He mentions it on that particular 8 one. 9 Q. The pathologist did not mention the presence of 10 H. pylori like organisms in any of the other ten slides, 11 correct? 12 A. That's correct. 13 Q. Okay. 14 (AT THIS TIME THERE WAS AN 15 OFF-THE-RECORD DISCUSSION BETWEEN MR. HYDE 16 AND MR. WIMBERLEY, AFTER WHICH THE 17 PROCEEDINGS RESUMED AS FOLLOWS:) 18 Q. Doctor, I'd like for you to -- And I've got it 19 right here, so it'll make it easier. Looking at the 20 November 1st, 1994, biopsy results -- or the pathology 21 results, I counted a few more samples, few more biopsies 22 than I think you originally counted. And I just want to 23 make sure if there's some mistake in my reading 24 or -- you know, or at least my ability to read this 25 - document. But it looks to me like -- 125 1 A. Wait a minute. 2 Q. -- there were more biopsies taken. 3 A. He starts out the sentence by saying, "Received 4 in formalin labeled "antrum" are seven biopsies varying 5 from 2 to 3 millimeters." Then he distributes them. In 6 other words, they put them into what they call 7 cassettes. And he says, submitted in to to as A I put 8 some; submitted are two of them into B and so many into 9 C and so many into D. And the way I interpret it is he 10 started out with seven biopsies, and he distributed them 11 amongst his cassettes. 12 Q. Okay. 13 A. Now, I don't know about his math here; but 14 Q. Okay. But 15 A. That's the way I would interpret this. 16 Q. Well, you've explained that to me: and I 17 appreciate that. On the December 8th sample result, the 18 H. P.-like organism was found in sample B; is that 19 right? 20 A. Yes. The proximal shave margin B. And then he 21 starts talking about that shave margin. 22 Q. Okay. There we go. And as Mr. Faulk pointed 23 out, there were 11 parts of the stomach that were 24 collected for this analysis; is that correct? 25 A. That's correct. 126 1 Q. Dr. Natelson, what types of cancers are 2 specifically -- Well, strike that. What types of 3 cancers do you contend are specifically caused by 4 infection of H. pylori? 5 A. Certain lymphomas and certain gastric 6 carcinomas would appear to be caused by H. pylori. 7 Q. And I'm certain of this, but I want to make 8 sure. Mr. Barrett did not have gastric carcinoma, 9 correct? 10 A. He did not have gastric carcinoma. 11 Q. Now, in any of the epidemiologic studies that 12 you've reviewed, have you seen any comparison in the 13 group of H. pylori infected individuals who have a 14 lymphoma and compare what percentage of those lymphomas 15 were large cell versus small cell? 16 A. All right. If you're talking about primary 17 gastric lymphoma, in some of these articles, it comments 18 what the numbers are. And I'd have to review that to 19 see which -- which types are the most common. It's late 20 and I'm getting sleepy. But both small cell lymphomas 21 and large cell lymphomas are seen with Helicobacter 22 infection. 23 Q. Do you know if the incidence of small cell 24 versus large cell lymphomas differ amongst those 25 individuals with H. pylori infection such that there are 127 1 more small cell lymphomas as compared to large cell 2 lymphomas in H. pylori infected individuals? 3 A. Well, I mean, you have to say that the concept 4 of MALT lymphoma has to do with small cell lymphomas as 5 the initial phase of the illness -- the initial 6 malignant phase and that the concept is that small cell 7 lymphomas. proceed into large cell lymphomas. So it 8 depends when in the course of the illness you decide to 9 make the diagnosis. 10 Q. Have you seen any pathology or any diagnosis of 11 Mr. Lester Barrett that would indicate that Mr. Barrett 12 ever had small cell lymphoma? 13 A. We see gastric nodules within the stomach in 14 this particular report. It's interesting to note that 15 there are benign lymphoid aggregates scattered in deep 16 zones of the edematous gastric wall. In other words, we 17 have normal lymphoid tissue in that stomach. We also 18 have what they describe as large cell lymphoma with a 19 background of marked chronic active gastritis. And in 20 the description, what we see is that in a particular 21 a typical lymphoma that's a large cell type, we don't 22 see normal lymphoid follicles. In other words, the 23 findings in this stomach suggest to me a progression 24 from lymphoid follicle to a large cell tumor in the 25 setting of chronic gastritis. That's what this report 128 1 shows. 2 MR. HYDE: I need to object to the 3 responsiveness. 4 (By Mr. Hyde) 5 Q. I probably had a -- And you probably told me a 6 lot of information. Any other time I'd probably 7 understand or at least have a feel for what it is. But 8 my question was very, very specific. Have you seen any 9 pathology report to indicate that Mr. Barrett had 10 specifically small cell lymphoma? 11 A. No. 12 Q. When you collect biopsies from someone with a 13 gastric lymphoma, normally how many samples do you 14 suggest should be collected? 15 A. Well, I don't normally make that suggestion. 16 That's generally left up to the gastroscopist, depending 17 what -- what that physician sees. One might be enough 18 if it's a good sample. 19 Q. Doctor, I promise we will be done by 10:00. 20 A. Okay. 21 MR. HYDE: And why don't we do this, 22 Ms. Court Reporter? Could you mark these, 23 please? 24 Q. And I assume that those are your original. 25 A. Yes. 129 1 Q. If you have some stickies, she can take them 2 back; and we can put a copy -- I mean, an exhibit 3 sticker on the copy so that you can have these back in 4 the original form unless you care. If you don't care, 5 then we'll put -6 A. I don't care. 7 MR. HYDE: Go ahead and put stickers 8 on it real quick. 9 MR. FAULK: Separately? 10 MR. HYDE: Huh? 11 MR. FAULK: Separately? 12 MR. HYDE: Yeah. Well, no. 13 (AT THIS TIME NATELSON EXHIBIT N0. 17 14 WAS MARKED FOR IDENTIFICATION PURPOSES AND 15 IS FULLY DESCRIBED IN THE "EXHIBIT INDEX" 16 HEREIN. SAME WILL BE FOUND AT THE 17 CONCLUSION OF THIS DEPOSITION. THERE WAS 18 AN OFF-THE-RECORD DISCUSSION, AFTER WHICH 19 THE PROCEEDINGS RESUMED AS FOLLOWS:) 20 (By Mr. Hyde) 21 Q. Doctor, would you identify generally the 22 documents that are contained in Exhibit 17? What are 23 they and of what use are they to you? 24 A. These are copies of articles from the medical 25 literature that generally deal with gastric lymphoma and 130 1 lymphomas of what we call the MALT category. Some of 2 them also deal with Helicobacter pylori and the 3 association between Helicobacter pylori and lymphomas. 4 Some have to do with non-Hodgkin's lymphoma in general 5 and classifications of that illness. Some have to do 6 with the relationship between Helicobacter pylori and 7 gastric cancer. And that would be the sum and substance 8 of these articles. 9 Q. And I think the last document in Exhibit 17 is 10 the IARC document, correct? 11 A. Correct. 12 Q. Have you made any kind of summary document 13 concerning the epidemiology that concerns non-Hodgkin's 14 lymphoma and H. pylori? 15 A. No. 16 Q. And you've reviewed, I take it, all the 17 epidemiological studies concerning non-Hodgkin's 18 lymphoma and H. pylori; is that correct? 19 A. All? I would say certainly not. I've reviewed 20 a substantial number of studies that I had in my file 21 and some from the recent literature. And I continue to 22 look at literature on the subject. But I -- I would be 23 presumptuous to say that I reviewed all of the 24 literature in this area. 25 Q. Did Mr. Faulk provide you with any of the 131 1 documents in Exhibit 17? 2 A. He provided me with I -- this manual that you 3 have, this IARC. 4 Q. Uh-huh. 5 A. I alerted him to its existence, and he then 6 procured it. 7 Q. Have you seen any documents in any of the 8 scientific or medical journals that concern when you 9 have a biological carcinogen and a chemical carcinogen, 10 what procedure should be used in weighing the 11 contribution of each of those carcinogens, that being a 12 biologic and chemical carcinogen, as it concerns the 13 formation of cancer in a person? 14 A. Well, it depends on, number one, what the 15 cancer is and what type of exposure one has had to a 16 potential carcinogen. I think it's difficult to answer 17 that question. You'd have to know what type of exposure 18 you have with the two possible etiologies. How close is 19 the relationship? How frequent is the cancer after 20 either exposure? There would be a number of factors 21 involved. 22 Q. As it relates to your analysis of Mr. Barrett, 23 you didn't have any benzene exposure data that 24 specifically concerned Mr. Barrett. 25 A. Correct. 132 1 Q. And, see, my question dealt with have you 2 reviewed any scientific papers that concern the 3 weighting process when you have exposure to two 4 carcinogens: one chemical, one biological 5 A. No. 6 Q. -- as to the role of those carcinogens in 7 causing cancer? 8 A. I haven't reviewed any such paper. 9 Q. Would you consider H. pylori a very common 10 infection in society? 11 A. Yes, and also depending on which society you're 12 talking about. It varies around the world. But it is 13 generally considered to be common. 14 MR. HYDE: Off the record. 15 (AT THIS TIME THERE WAS AN 16 OFF-THE-RECORD DISCUSSION, AFTER WHICH THE 17 PROCEEDINGS RESUMED AS FOLLOWS:) 18 MR. HYDE: Go back on the record. 19 (By Mr. Hyde) 20 Q. Have you reviewed any serology studies 21 concerning Mr. Barrett, specifically whether the 22 antibody for H. pylori was present in Mr. Barrett's 23 blood? 24 A. I did not -- If it's in there, I-didn't notice 25 it. I don't recall that determination. 133 1 Q. Doesn't IARC suggest that most gastric 2 lymphomas caused by H. pylori are the small cell type? 3 A. Well, we'll look at what it said. But you also 4 have to keep in mind that -- when this was written, and 5 these concepts are developing. This was written in 6 1994. 7 Q. Well, you'd certainly consider 1994 - a 8 reasonably current document. 9 A. Reasonably current. But many areas of medicine 10 change surprisingly rapidly. Let's look specifically to 11 see what they say. 12 MR. FAULK: Off the record. 13 (AT THIS TIME THERE WAS AN 14 OFF-THE-RECORD DISCUSSION, AFTER WHICH THE 15 PROCEEDINGS RESUMED AS FOLLOWS:) 16 A. On Page 17 MR. HYDE: Well, let's go off the 18 record and make sure you've got it, Doctor. 19 (AT THIS TIME THERE WAS AN 20 OFF-THE-RECORD DISCUSSION, AFTER WHICH THE 21 PROCEEDINGS RESUMED AS FOLLOWS:) 22 MR. WIMBERLEY: Go back on. 23 A. It was the 24 Q. Let me see if I can find it again. Really, if 25 you -- 134 1 MR. WIMBERLEY: Small cell. 2 MR. HYDE: Oh, yeah. Yeah. Yeah. 3 (By Mr. Hyde) 4 Q. Does it say in the IARC document that the small 5 cell type of gastric lymphoma is the type of lymphoma 6 most associated with H. pylori? 7 A. Well, it doesn't -- The paragraph I have in the 8 summary doesn't say that. They simply talk about 9 lymphoma and mucosal-associated lymphoid tissue 10 lymphomas. And they don't talk about a specific type in 11 the summary. 12 Q. Are those types of lymphomas typically small 13 cell? 14 A. Generally speaking, small cell lymphoma is the 15 more frequent lymphoma that one sees. 16 Q. Let me get to your report. I will tell you 17 what. 18 MR. HYDE: Go off the record one 19 second. 20 (AT THIS TIME THERE WAS AN 21 OFF-THE-RECORD DISCUSSION, AFTER WHICH THE 22 PROCEEDINGS RESUMED AS FOLLOWS:) 23 (By Mr. Hyde) 24 Q. Dr. Natelson, do you have any idea whether Mr. 25 - Barrett's parents had cancer? 135 1 A. In my report I mention both his parents had 2 some form of cancer, but the type was not mentioned in 3 the records. 4 Q. And, again, you're not in any way associating 5 that fact, which I don't know to be true, that his 6 parents may have had some type of cancer, as any -- as 7 having anything to do with Mr. Barrett's lymphoma, 8 correct? 9 A. Well, I don't know what type of cancers they 10 were: so there's not much I can do with that piece of 11 information. 12 Q. Mr. Barrett also had some significant vascular 13 problems or significant vascular disease in 1996, 14 correct? 15 A. Yes. 16 Q. One of the side effects of chemotherapy, is it 17 not, is an effect upon the heart: is that correct? 18 A. Yes. 19 Q. And it's possible that his vascular disease was 20 caused as a result of his chemotherapy, correct? 21 A. No. I wouldn't agree with that statement. 22 Q. You see no possibility? 23 A. No possibility. 24 Q. Have you seen any scientific literature 25 concerning vascular disease and chemotherapy? 136 1 A. With respect to the chemotherapy that he 2 received? 3 Q. Yes, sir. 4 A. No. 5 Q. And did you do any research in that area for 6 Mr. Faulk? 7 A. No. 8 Q. You have seen no evidence that Mr. Barrett had 9 chronic gastric infection based on specific pathology. 10 MR. FAULK: Object. That 11 mischaracterizes his testimony regarding 12 the surgical pathology report. 13 Q. Other than the one sample collected on December 14 8th, 199 -- Well, let's -- I'm sorry. Let me rephrase 15 that. I don't have many questions left. I'm trying to 16 get this over with, but I don't want to rush this. You 17 say in your report, "By contrast, the notion that 18 benzene and other chemicals may cause lymphoma, in man, 19 remains speculation." That's a correct reading, isn't 20 it? 21 A. That's correct. 22 Q. Though you are aware of some literature that 23 attributes benzene exposure to non-Hodgkin's lymphoma, 24 correct? 25 MR. FAULK: Object. That 137 1 mischaracterizes his testimony. 2 A. Well, I'm aware of literature in which the 3 association has been suggested because of epidemiologic 4 data. 5 Q. Doctor, have you been asked to prepare any 6 demonstrative aids relative to your testimony in this 7 case? 8 A. No. 9 Q. And do you plan on doing such work as we sit 10 here today? 11 A. Well, I've discussed it with Mr. Faulk in terms 12 of diagrams: but I haven't prepared any. 13 Q. Have you in the past utilized demonstrative 14 aids relative to your work as an expert witness? 15 A. No. 16 Q. What have you discussed with Mr. Faulk 17 specifically concerning the demonstrative aids relative 18 to your testimony in Mr. Barrett's case? 19 A. Well, we've discussed illustrating the concept 20 of MALT lymphoma. 21 MR. FAULK: That's about as general as 22 it gets. 23 (AT THIS TIME THERE WAS AN 24 OFF-THE-RECORD DISCUSSION, AFTER WHICH THE 25 PROCEEDINGS RESUMED AS FOLLOWS:) 138 1 Q. Do you know of any other risk factors for 2 non-Hodgkin's lymphoma that in any way would be a risk 3 factor for Mr. Barrett in the development of his 4 non-Hodgkin's lymphoma other than what we've talked 5 about already? 6 A. Well, I'd have to look again. I've forgotten 7 from the records. We know -- And there are increasing 8 reports in hepatitis C being associated with 9 non-Hodgkin's lymphoma. And I think he had hepatitis 10 testing done, but I just can't recall. But if he didn't 11 have hepatitis testing done and one found he was 12 positive for hepatitis C, that potentially could be a 13 risk factor. 14 Q. As we sit here today, you have no evidence that 15 Mr. Barrett had hepatitis C; is that correct? 16 A. No, I do not. 17 Q. Let me phrase it this way. Do you have any 18 evidence that Mr. Barrett has or has ever had hepatitis 19 C? 20 A. No, I do not. 21 Q. Have you examined the cost for the treatment of 22 Mr. Barrett for his lymphoma? 23 A. Well, specific reference to his hospital bills, 24 you're talking about? 25 Q. Yes, sir. 139 1 A. No. 2 Q. So you have no opinions as to whether the 3 medical costs were reasonable or not; is that correct? 4 A. No. I have no opinions about that. 5 Q. And were you provided with Dr. Spindel's report) 6 concerning what his opinion was as to what may have 7 caused Mr. Barrett's non-Hodgkin's lymphoma? 8 A. I don't recall. If it's in that pile of 9 documents, then at some time I saw it: but I don't 10 recall seeing it. 11 (AT THIS TIME NATELSON EXHIBIT NO. 18 12 WAS MARKED FOR IDENTIFICATION PURPOSES AND 13 IS FULLY DESCRIBED IN THE "EXHIBIT INDEX" 14 HEREIN. SAME WILL BE FOUND AT THE 15 CONCLUSION OF THIS DEPOSITION.) 16 Q. Doctor, I've had marked as Exhibit 18 Dr. 17 Spindel -- one of Dr. Spindel's reports concerning Mr. 18 Barrett. Do you specifically recall seeing this 19 document prior to today's deposition? 20 A. I don't recall seeing this document. 21 Q. And Dr. Spindel states that in his opinion 22 exposure to benzene is a risk factor concerning Mr. 23 Barrett's non-Hodgkin's lymphoma, correct? 24 A. No. He doesn't say that at all. 25 , Q. Okay. Let me see it, please 140 1 A. (Tendering document.) 2 Q. Dr. Spindel states, "I recognize that benzene 3 exposure is a risk factor in developing lymphoma under 4 reasonable medical probability." He did say that, 5 correct? 6 A. He's -- But not with specific reference to the 7 patient. 8 Q. Yes. But he said what I said he said. 9 A. No. You said he said that 10 Q. Okay. 11 A. You mentioned, I believe, the patient. 12 Q. I see where the confusion is. 13 A. Okay. 14 Q. Dr. Spindel in Exhibit 18 states, "I recognize 15 that benzene exposure is a risk factor in developing 16 lymphoma under reasonable medical probability," correct? 17 That's what he said? 18 A. That's what it says there. But -- but that 19 doesn't mean that it applies to this particular patient. 20 Q. Well, when it says, "Referencing Charles Lester 21 Barrett," do you have any reason to believe that he'd be 22 talking about anybody else other than Charles Lester 23 Barrett? 24 A. Well, I mean, this -- this person writing the 25 letter mentions what he did that -- It says he's a 141 1 practicing physician, that he's treated someone for 2 large cell lymphoma. And then he has a paragraph that 3 says benzene is a risk factor for developing lymphoma. 4 But there might be many other risk factors, and he's 5 not -- I don't see any place where he says this guy has 6 lymphoma from this particular risk factor. 7 Q. Do you agree or disagree with the statement 8 benzene is a risk factor in the development of Hodgkin's 9 lymphoma? 10 A. I disagree. 11 Q. But certainly if the epidemiological studies 12 evolve, that opinion is something that is subject to 13 change, isn't it? 14 A. Well, over the years medical opinions change on 15 many issues. 16 MR. HYDE: We're done. 17 MR. FAULK: Just a second. I may 18 have 19 MR. HYDE: Oh, okay. 20 MR. FAULK: -- just short redirect. 21 Matter of fact, I probably do. We'll just 22 go ahead and do it. It won't take long. 23 EXAMINATION BY MR. FAULK: 24 Q. Dr. Natelson, do you recall in your testimony 25 earlier in this deposition -- I know it's been a 142 1 while -- that you referred to a level of -- I think it 2 was 200 PPMs that was necessary to induce hematopoietic 3 cancers by benzene? 4 A. Yes. 5 Q. Have you had an opportunity to think about 6 that? And is that still your testimony? 7 A. Well, I think we also talked further after that 8 statement was made; and I mentioned that what we're 9 talking about is part per million years or cumulative 10 exposure over time. 11 Q. And is that based on any materials that you've 12 reviewed? 13 A. That's based on the opinions in part of Dr. 14 Wong in some of the papers I've reviewed. 15 Q. And do you recall whether or not you reviewed a 16 risk assessment done by Dr. Wong? 17 A. Well, that one particular paper involved risk 18 assessment, yes. 19 Q. When did you first have an opportunity to 20 review the opinions -- any opinions expressed by any of 21 the Plaintiff's experts in this case? 22 A. Well, this is the first time I've seen this 23 particular letter, which would be that opinion. 24 Q. And 25 MR. HYDE: Off the record. 143 1 (AT THIS TIME THERE WAS AN 2 OFF-THE-RECORD DISCUSSION, AFTER WHICH THE 3 PROCEEDINGS RESUMED AS FOLLOWS:) 4 Q. You've reviewed an affidavit-by Dr. Gardner; is 5 that correct? 6 A. Yes. 7 Q. And did you review that within the last month? 8 A. Probably, yes. 9 Q. Was that the first time that you knew of Dr. 10 Gardner's opinions in this case? 11 A. Yes. 12 Q. And have you yet had an opportunity to review a' 13 deposition of Dr. Gardner? 14 A. No. 15 Q. Or a deposition of any of the Plaintiff's 16 experts? 17 A. No. 18 MR. FAULK: That's all I have. 19 RE-EXAMINATION BY MR. HYDE: 20 Q. Doctor, did you know that the depositions of 21 Dr. Lemmon and Dr. Bingham have already been 22 transcribed; and they're two of Plaintiff's experts? 23 A. I don't know either of those people. I don't 24 know anything about that. 25 Q. And you haven't received any testimony from 144 1 those individuals, correct? 2 A. No. 3 Q. I believe you've testified before that you knew 4 Dr. Gardner; is that correct? 5 A. Yes, I know Dr. Gardner. 6 Q. And as a hematologist you have respect for him, 7 correct? 8 A. Yes. 9 Q. What specific paper from Dr. Wong have you 10 reviewed concerning risk assessment? I mean, can you 11 identify that for me as we sit here? 12 A. No, because I have all his papers over in my 13 other office. It's not among the papers I brought here 14 today. 15 Q. And I take it those are papers that have been 16 provided to you by lawyers representing defendants 17 some of them? 18 A. No. Those are papers that I've accumulated 19 over the years that have to do with different subjects 20 in hematology. 21 Q. As we sit here today, do you have an opinion as 22 to what is a safe level of benzene exposure? I know you 23 didn't in the Frias deposition. Do you have one today? 24 A. Well, I don't have a particular safe level. 25 We're talking about -- As we said, a certain number of 145 1 parts per million years can be very dangerous and may 2 cause acute leukemia; but that level should be very 3 high. 4 Q. As we sit here today, do you know specifically 5 of a safe exposure level to benzene with no risk? 6 A. With no risk associated to it? 7 Q. Yes, sir. 8 A. I'd have to say no. 9 Q. And certainly you agree that -- agree with the 10 concept of individual susceptibility and that some 11 individuals may be more susceptible to the effects of 12 benzene as compared to others, correct? 13 A. Well, I don't know that to be a fact. 14 Q. Do you disagree with that? 15 A. Well, I don't -- I don't know -- I don't have 16 an opinion on it. 17 Q. That's fair enough. 18 A. I don't know. 19 Q. So the record's clear, you have no opinion as 20 to individual susceptibility of a benzene-related 21 disease from benzene exposure; is that correct? 22 A. No. I don't -- I -- What we know is that 23 benzene exposures that cause acute leukemia require 24 generally very high levels in the range, as we said, 25 cumulative part per million years 100 to 200 or so. 146 1 Now, someone might require 100. Some of them might 2 require 200. But they require a bunch. 3 Q. Have you formulated any other opinions other 4 than those stated in your report and those contained in 5 this deposition as it relates to Mr. Lester Barrett? 6 MR. FAULK: I'm going to object to the 7 question, as you did, with respect to the 8 witness's last week. It's up to you to ask 9 the questions to elicit the opinions. I 10 think that question's too vague. 11 MR. HYDE: Good. That verifies my 12 other objection. That's all the questions 13 I have. 14 (AT THIS TIME THE DEPOSITION WAS 15 CONCLUDED.) 16 17 18 19 20 21 22 23 24 25