Document ZBv0d1QYN3Qr1LYkE04YvZL67

1 1 SUPERIOR COURT OF NEW JERSEY LAW DIVISION: MIDDLESEX COUNTY 2 DOCKET NO. L-060148-87 3 JOHN PETERSON and SHIRLEY MAS PETERSON, 4 his wife, 5 Plaintiffs, DEPOSITION UPON 6 vs. ORAL EXAMINATION OF: SAMUEL S. EPSTEIN, M.D. 7 UNION CARBIDE CORPORATION, 8 De fendant 9 :o 11 12 1 3 TRANSCRIPT of the deposition notes of SAMUEL S. EPSTEIN, M.D., witness, called for oral 1 4 examination in the above-entitled action, said deposition being conducted pursuant to the Rules 15 Governing Civil Practice in the Superior Court of New Jersey, by and before CINDY L. NAGLE, a Notary Public : 6 and Certified Shorthand Reporter of the State of New Jersey, License No. XI01434 at the offices of 17 Scadden, Arps, Slate, Meagher & Flom, Esquires, 919 Third Avenue, New York, New York 10022, on December 18 1, 1989, commencing at 10:25 a.m. 19 20 21 22 AGENT FOR REPORTING SERVICES: 23 ROBERT CIRILLO, INC. 24 Certified Shorthand Reporters 5 N - Regent Street - Suite 503 2 5 Livingston, New Jersey 07039 (201) 740-1331 RNW 2221 2 1 APPEARANCES: 2 LEVINSON, AXELROD, WHEATON & GRAYZSL, ESQUIRES BY: ALFRED LEVINSON, ESQ. 3 Attorneys for Plaintiffs 4 PITNEY, HARDIN, KIPP & SZUCH, ESQUIRES 3Y: ROBERT L. HOLLINGSHEAD, ESQ. 5 Attorneys for Defendant 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 RNW 2222 3 1 SAMUEL S. EPSTEIN, Apartment 25M 2 860860 North Lake Shore Drive, Chicago, Illinois 3 60611, having been duly sworn by the Notary, 4 testifies as follows: 5 6 DIRECT EXAMINATION BY MR. HOLLINGSHEAD: 7 8 Q. Doctor, good morning. Let me introduce 9 myself for the record. I am Robert Hollingshead with 10 the law firm of Pitney, Hardin, Kipp & Szuch. We 1 1 represent the Defendant, Union Carbide Corporation in 1 2 this action that was instituted by Mr. and Mrs. 13 Peterson on whose behalf you have submitted an expert 1 4 report . 1 5 As you know, and as I'm sure you are 1 6 very familiar with this, this is a deposition of 17 which is a time for me to inquire into that expert 1 8 report and the various reports and factual 19 information that are behind it. 20 Again, since I know you are familiar 2 1 with depositions, I will give you a couple of 22 cautionary notes. 23 One is, please allow me to finish my 24 question before you start your answer and I will do 2 5 you the courtesy of allowing you to finish your RNW 2223 EPSTEIN - Direct/Hollingshead 4 1 answer before I ask the next question. 2 Secondly, please keep all of your 3 responses verbal on behalf of the reporter who cannot 4 interpret nods of the head or shakes of the head. 5 Thirdly, if you have any question 6 whatsoever about my question, either it's not clear 7 or perhaps has a misstatement of fact in it, please 8 tell me so and I will do the best I can to rephrase 9 it until you understand it. 1 0 Obviously, if Mr. Levinson has any 1 1 objections to my questioning, you should allow him to 1 2 put those objections on the record and then we will 1 3 proceed with his instruction to you as to whether you 1 4 may answer or not, or if the objection can be worked 1 5 out between us, I will rephrase the question. 1 6 A. Sure. 1 7 Q. All right, do you have any questions 18 before we begin? 19 A. No, not at all, thanks. 20 Q. Do you happen to have with you today a 2 1 current or reasonably current curriculum vitae or 2 2 resume ? 2 3 A. I'm terribly sorry, I haven't, but I can ship 24 it to you on Monday. 25 Q. Would you please do so? RNW 2224 EPSTEIN Direct/HoIIingshead 5 1 A. Yes , let me make a note of it. 2 Q Sure . 3 A. Okay . 4 Q Without the benef it of that resume, let 5 me just go through a few questions with regard to 6 your background. 7 I should note for the record initially 8 and as I think, Dr. Epstein, you recall I took your 9 deposition approximately ten years ago in a different 1 0 matter. I believe at that time we went through a 1 -1 fair amount of your background and so what I might 1 2 wish to do is simply try to bring it current to a 1 3 certain extent in the last ten years. 14 What is your current position, Dr. 15 Epstein? 1 6 A. Same as it was then, professor of occupational 1 7 and enviornmental medicine. School of Public Health 18 University of Illinois Medical Center, Chicago. 19 Q. Has there been any change in that 20 position that you hold at the University of Illinois 2 1 Medical Center in the past ten years? 22 A. No . 2 3 Q. What degrees have you been awarded 24 through your educational process and when were they? 25 A . None since 1980. RNW 2225 EPSTEIN Direct/Hollingshead 6 1 Q. Just refresh my recollection, this in 2 regard as to what your degrees are that you hold? 3 A. I have a 3.Sc., in the '46, M3BS, which is the 4 university degree in medicine, in England. D Path, 5 that's a degree in pathology, DTM&H degree in 6 tropical medicine and hygiene and M.D., which is the 7 most advanced degree in internal medicine, I think 8 experimental medicine and sundry honorary degrees. 9 Q. 1 0 England? Was the M.D. conveyed upon you in 1 1 A. Yes, all ofthese were in London University. 1 2 Q. When did you receive your M.D.? 1 3 A. 1958. The M.D. isn't the qualifying 1 4 examination, it has no privilege equivalent to this. 1 5 The equivalent to the American M.D. is the M.D. B.S. 1 6 which I got in 1950. 17 Q. You say that's the equivalent of the 1 8 United States version ofthe M.D.? 19 A. Correct. 20 Q. Have any degrees been conveyed upon you 2 1 as a result of any education in the United States? 22 A. No . 23 Q. Are you a licensed physician of any 24 state in the United States? 25 A. No . RNW 2226 EPSTEIN Direct/HoiIingshead 1 Q. In your position as professor of 7 2 occupational and environmental medicine at the 3 University of Illinois Medical Center, do you have a 4 practice wherein you diagnose, treat or see patients 5 at ail? 6 A. No . 7 Q Do you have any board certifications in 8 the United States? 9 A. No . 10 Q. When you provide me with your C.V., will 1 XX it have a list of publications that you have authored 1 2 over the course of time? 1 3 A. Yes. 1 4 Q. And up until the reasonably recent time 1 5 frame? 1 6 A. Yes. 17 Q. Are any of those publicat ions , to your 1 8 reco1lection , on the subject of any of the chemicals 19 that are in this case , and let me name them if I may 20 as I understand them and as I read your report, 2 1 polyvinyl chloride, vinyl chloride monomer, 2 2 polystyrene, isopropi1idene resin and various 23 chemicals that are emanated by welding fumes which we 24 will get to in more detail later? 25 A. Yes, I think I discussed several of these in a RNW 2227 EPSTEIN - Direct/Hollingshead 8 1 book called th^ Pa r 11 c u 1 a r s of Cane e r j pub 1 i shed in 2 1978/79, the asbestos, the vinyl chloride, polyvinyl 3 chloride. 4 It's very possible I have some 300 5 publications, likely that several of these chemicals 6 have been discussed, but to be quite frank, offhand I 7 can't recal1. 8 Q. In my list of the chemicals a moment ago 9 as you pointed out in your answer, I did forget to 1 0 list asbestos, I did not mean to do so. 1 1 A. Oh, that's okay. 1 2 Q. Dr. Epstein, in the past ten years, have 1 3 you appeared in any piece of litigation which PVC or 14 polyvinyl chloride has been an issue? 1 5 A. Yes. 1 6 Q. Would you tell me, if possible, 1 7 approximately how many? 1 8 A. Sure, I have these listed here. 19 Q. Did you prepare that list in response to 20 the Notice of Deposition that I supplied to you? 2 1 A. Yes, I tried to anticipate all of the 2 2 questions. 2 3 Q. Very good. 24 A. Prior VC/PVC Litigation, I will start in the 25 beginning. You did say the last ten years? RNW 2228 EPSTEIN - D1 rect/Ho 11ingshead 9 1 Q. I did. Let's go back all the way, 2 perhaps we can start with the first time? 3 A. The first case was Elias versus Parke Davis 4 and Sprayon in 1979. I was deposed in that case but 5 to the best of my recollection there was no trial. 6 Q. What was the issue, very briefly? 7 A. It was an infant that had surgery, and I think 8 it was for a congenital Pyloricstenosis. And on a 9 few occasions, two or three occasions, the incision 10 scar was sprayed with a material called Sprayon, 1 1 which when it hardens it forms a kind of an elastic 1 2 bandage so you don't have to use sutures, to minimize 1 3 the need for sutures and VC was the propellant, vinyl 1 4 chloride, and the infant subsequently developed a 1 5 malignant tumor known as hepato blastoma and I was 1 6 the expert in that case and it was settled after that 1 7 deposition. 1 8 The next was Maliko et al versus Union 19 Carbide in 1979, which of course you're both 20 familiar. 2 1 The third was Grasso versus B.F. 2 2 Goodrich in 1981, in which Dr. Davidson referred to 23 in his deposition. This is a man who lived about one 24 and three quarter miles from a B.F. Goodrich Plant, 25 didn't work in the plant, but he died from RNW 2229 EPSTEIN - Direct/Ho11Ingshead 10 1 angiosarcoma of the liver. I testified there, I was 2 deposed there and also testified at trial. 3 The fourth case -- am I going too fast 4 for you ? 5 Q . No . 6 A. Fourth case, Mikyska versus Ford and Union 7 Carbide in '81, in which I was deposed. This was 8 workers at a Ford plant involved in PVC fabrication 9 and exposed to VC as a result of that and developed a 10 toxic hepatitis, and again I was deposed there and it 1 1 was settled, to the best of my recollection, without 1 2 trial. Those are the only four cases that I have any 1 3 recollection or any record of. 14 Q. In the Grasso case, what was the 1 5 exposure that Mr. Grasso sustained in his residence 1 6 one and three quarter miles from the plant? 1 7 A. Well, vinyl chloride. 18 Q. Not fumes? 19 A. Yes, to the emissions from the plant and these 20 were based on emission data of farmer plant material, 2 1 balance studies, modeling and air dispersion data, we 2 2 had no actual monitoring data. 2 3 Q. That was not a resin, it was a VC/PVC 24 emission case? 2 5 A. It was VC/PVC plant but the exposure was to RNW 2230 EPSTEIN - Direct/Ho 111ngshead 11 1 VC . 2 Q. Do you keep copies of the expert reports 3 that you render? 4 A. When I write a formal report I keep those, 5 otherwise all I do for an old case is to simply keep 6 a letter of the attorney and possibly one or two 7 scraps of paper. 8 Q. Do you have a recollection as to whether 9 you wrote a formal report in the Elias matter? 10 A. I don't think I did but I'm certainly willing 1 1 to check. 1 2 Q. Would you please do that? 1 3 A. Sure. What you don't need is obviously the 14 Maliko stuff, you have that already. 15 Q . No . 1 6 A. I will check to see if I have formal reports 17 on any of those other cases. 1 8 Q. And also -- 19 A. On three cases. 20 Q. Elias, Grassoand Mikyska. 2 1 A. VC prior litigation cases. 22 Q. Do you alsoretain deposition 23 transcripts if they are provided to you? 24 A. Sometimes I do, sometimes I don't. It depends 2 5 how interested I am in them. If they are of RNW 2231 EPSTEIN - Direct/Hollingshead 12 1 particular interest to me I would retain them, absent 2 to that I wouldn't. 3 Q. May I ask you to check for those too, 4 and if you have them, advise Mr. Levinson? 5 A. If I do have that stuff, do you want my office 6 to copy them and send them to you or do you want me 7 to send you the originals? 8 Q. You can have your office copy them and 9 bill me for the copying. 10 A. Fine. 1 1 Q. What files do you retain on other 1 2 litigations in which you've appeared? 1 3 A. I generally keep virtually nothing, with the 1 4 exception I have a letter from the attorney and if 1 5 there's anything of a particular scientific interest 1 6 I keep, otherwise once a case is over I discard the 1 7 material. 18 I would keep any written report clearly 1 9 and that's about it. Sometimes I would keep a 20 summary, if, for instance, I had done a survey or a 2 1 chart on that I would keep that because clearly there 2 2 was work involved and I wouldn't want to throw that 23 away . 24 Q. I would like to see any documentation 2 5 that you have on any of these matters which might RNW 2232 EPSTEIN - D1rect/Ho 11Ingshead 13 1 include correspondence with the attorneys or 2 identification of the attorneys for the defendants. 3 A. Sure . Also other paperwork, with pleasure, 4 except for the Maiiko. 5 6 A. Q Excluding Maliko -- Okay , e t a 1 . 7 Q -- Which I appeared ten years ago and I 8 have those papers. 9 A. Yes, all right. 1 0 Q. Have you appeared in any cases prior to 1 1 this litigation in which you have rendered an opinion 1 2 on the chemical Polystyrene? 13 A. No . 1 4 Q. If memory serves, was Polystyrene 1 5 involved in the Maliko case? 1 6 A. Yes. 1 7 Q. Would that be the only one then? 18 A. That's correct. 19 I'm sorry, my previous answer was 20 incorrect. I had, in fact, it was in the Maliko 2 1 case, I beg your pardon. 2 2 Q. I seem to recall that there were other 23 chemicals in that case, too, but that was one of 24 them? 2 5 A. Yes. RNW 2233 ft EPSTEIN - D1rect/Ho 11ingshead 14 1 Q. But the main focus was PVC, if I recall? 2 A. Correct. 3 Q. Have you given expert reports in any 4 other case on the chemical asbestos? 5 A. I've been involved in very little asbestos 6 litigation, one or two, and I can't recall whether 7 I've done any reports. 8 Again, I can check on that if you like. 9 Q. Would you please? 10 A. Three; check reports on asbestos litigation. 1 1 Okay . 1 2 Q. And to round out the listing here, have 1 3 you written any other expert reports on 14 Isopropi1idene Bisphenol Resins? 1 5 A. I've been involved in one case on Bisphenol A, 1 6 and I will do the same also. 1 7 Q. All right. 18 Now, do you equate Bisphenol A with 19 isopropi1idene resins? 20 A. Yes. 2 1 Q. Let me remind you that Bisphenol A 22 wasn't in the Maliko case. 23 A. Yes, when you ask me for any paperwork I'm 2 4 excluding Maliko. 25 Q. But I do want your testimony to be RNW 2234 EPSTEIN - Direct/HoIIingshead 15 1 accurate and although you and I are assuming Maliko 2 is not involved, the Bisphenol A report you rendered 3 in Maliko was one of those? 4 A. Correct. 5 Q. But you don't need to send that to me. 6 We also have at issue in this case as I 7 read your report basically emissions from welding 8 fumes. Have you had occasion to write an expert 9 report on that subject prior to Peterson? 10 A. No . 1 1 Q. Tell me very briefly what your current 1 2 responsibilities are as professor of occupational 1 3 medicine at the University of Illinois Medical 14 Center? 1 5 A. Research, teaching and public service. 1 6 Q. Do you have a teaching course load at 1 7 this present time? 18 A. Yes . 19 Q. Can you tell me what it is now? 20 A. I basically do one intensive course a year, 21 generally the winter course in which I go in great 2 2 depth into a series of current issues that have a 2 3 scientific, strong scientific involvement in 24 environmental or occupational matters and discuss 25 these from a set of prospectives, including the RNW 2235 EPSTEIN - Dlrect/Hollingshead 16 1 scientific, the decision making, the regulatory and 2 regulative and this is basically more advanced 3 students, postgraduate students of Ph.D. or M.D. who 4 want to get further training in public health, so 5 it's a fairly advanced course which I teach, I gave 6 major assignments, I work with the students on this. 7 Q. Is that a course that you are teaching 8 now? 9 A. Yes, I will be teaching in January. 10 Q. So for this fall you have not had a 1 1 teaching load at all? 12 A. No . 13 Q. What is the research that you do 1 4 presently at the University of Illinois? 15 A. I research a fairly wide range of issues; from 1 6 problems with pesticides to on one hand problems of 1 7 air pollution, problems of internal combustion, 1 8 engine, gasoline, problems of hormones, the use of 19 biotechnology and dairy farming, it's a wide range. 20 Q. When you use the word research in your 2 1 answer, Dr. Epstein, what do you mean by that? 2 2 Are you talking about book research, if 23 I may call it that? 24 A. At this stage it's largely book research and 25 scientific publications based on book research, yes. RNW 2236 EPSTEIN - D1rect/Ho 11Ingshead 17 1 Q. Do you have graduate students assisting 2 you in any of your research? 3 A. No . 4 Well, only insofar as if indeed in the 5 course of my teaching a particular topic or issue 6 pops up which one of the students wants to develop in 7 great detail with me, I would then publish an 8 example. For instance, in last year's course I had a 9 from University of Chicago who was 10 one of the students, and based on the course we did a 1 1 joint publication in environmental occupational 1 2 causes of colorectal cancer. So only incidentally 1 3 that way, but I don't work with students on my 14 publications, it's only as an outcome of any course I 1 5 happen to do. 1 6 Q. Do you mean to exclude from that any 1 7 research you might do with regard to litigation in 1 8 which you are appearing? 19 A. Oh, no. 20 Q. Let me go back then in terms of research 2 1 that you do at the University of Illinois. Would it 22 also include what I might refer to as ad hoc research 2 3 in order to render an opinion in a particular case? 24 A . That wouldn't be part of my university 2 5 Q. That would be part of your practice as a RNW 2237 EPSTEIN - Direct/Ho 11ingshead 18 1 consultant? 2 A. Precisely. 3 Q. Thank you for the distinction. 4 Let's stay with your work at the 5 University of Illinois then. How much time on a 6 weekly basis do you spend in your capacity as a 7 professor with the University of Illinois? 8 A. I have a 90 percent appointment, so I'm part 9 time with the University. 10 Q. I'm not too sure I know what that means? 1 1 A. Ninety percent; in other words, I'm not full 1 2 time so I'm paid on a 90 percent basis not a 100 1 3 percent basis, which means that I, over and above 1 4 whatever time, generally most people take about a day 1 5 a week on private work, I have a little extra time 16 because I'm only 90 percent as opposed to 100 percent 1 7 so that's about an extra half day. 18 Q. Take the last six months or so, if you 19 could, and take average, could you tell me how much 20 time during the course of a week you might spend on 2 1 university responsibilities and how much time on your 2 2 consulting practice? 23 A. Well, my university work would be generally 24 about four days a week. 25 Q. And generally would the fifth day of the RNW 2238 EPSTEIN - D1rect/Ho 111ngshead 19 1 week, If we assume that we're talking about a five 2 day work week, would that be devoted to your 3 consulting work? 4 A. Yes. 5 Q. And is your consultant work primarily in 6 the area of litigation? 7 A. I would say it's almost exclusively an area. 8 yes . 9 Q. During the course of the past five years 1 0 or so, have you consulted at all with any 1 1 manufacturing or chemical companies on their bahalf? 1 2 A. I don't think any have invited me. 1 3 Q. Okay. 1 4 A. I'm always open. 15 Q. Has your work been pretty much 1 6 exclusively on behalf of injured individuals in 1 7 various capacities? 18 A. Correct . 19 Q. Would you say that over the course of 20 the past five years your work load in terms of it 2 1 being split between the university and consulting 2 2 practice has been the same as you've indicated for 2 3 me, that is four days a week for the university and 24 one day a week for consulting practice? 25 A . Yes . RNW 2239 EPSTEIN - Direct/Ho 11ingshead 20 1 Q. In the course of your consulting work, 2 have you ever appeared in a case or rendered a report 3 in any litigated case where the injured person had a 4 laryngeal cancer prior to Mr. Peterson's case? 5 A. Yes. 6 Q. Can you recall for me some of the 7 details of that? 8 A. I think I can. I think it was a worker in a 9 NASA plant. 10 Q. That's the National Aeronautics and 1 1 Space Administration Plant? 1 2 A. Yes. Who was exposed to a fairly wide range 1 3 of agents and developed laryngeal cancer. I forget 1 4 the name of it, but I can try and find it for you and 1 5 send you whatever paperwork I have. 1 6 Q. Thank you, I would appreciate that. 17 Is your recollection that that is the 1 8 only prior situation wherein which you've appeared 19 where there was a laryngeal cancer? 20 A. Well, minor correction, with due respect I 2 1 didn't appear. In fact, I'm not even sure what -- I 22 think there was a depo, yes. Well, okay, so I think 23 there was a depo but no trial and excepting that and 24 of course the Maliko, Wilkinson. 2 5 Q. One of the individuals? RNW 2240 EPSTEIN - Direct/Ho 11ingshead 1 A. Wilkinson. 21 2 3 A. Q. Was it Wilkinson? Precisely. 4 Q. But other than those two instances you 5 don ' t have a recollection of appearing in any other 6 cases in which there was a laryngeal cancer? 7 A. No . 8 Q. Correct me if I'm wrong, Dr. Epstein, 9 but you would not be qualified to sit to take any 10 board certification examination in the United States? 1 1 A. No, I haven't. I don't have a medical 1 2 qualification in this country. 1 3 Q. Which would be necessary to do that? 14 A . Yes . 15 Q. How did you become involved in this 1 6 case , the Peterson case? When was your initial 17 contact with Mr. Levinson? 1 8 A. Mr. Levinson wrote to me in April of '88 and 19 mentioned the case and then both of us seemed to have 20 let the matter drop for another six months or so, and 2 1 about January of this year Mr. Levinson called me 2 2 again and got me started on the case. 2 3 So really, I didn't formally get 24 involved until the beginning of 1989. 2 5 Q. When Mr. Levinson called you in April of RNW 2241 EPSTEIN - Direct/Ho 11ingshead 22 1 19 -- 2 A. Excuse me, he wrote to me. 3 Q. I'm sorry, you did say that. When he 4 wrote to you in April of 1988, did he provide you 5 with any information or materials with regard to the 6 case? 7 A. No, just a letter in which hetalked very 8 briefly about the case, then I believe subsequent to 9 that we had a brief discussion and I agreed in 1 0 principle to get involved, but we didn't actually get 1 1 started until about January of this year. 1 2 Q. In January of 1989, I think you said 1 3 that he called you again and got you started on it? 14 A. Correct, yes. 15 Q. Was there further correspondence at that 1 6 time advising you as to details of the case? 17 A . Yes . 18 Q. And did you receive materials from Mr. 19 Levinson at that time? 20 A. Well, I don't know exactly at that time, but 2 1 on an ongoing basis subsequent to that Mr. Levinson 2 2 sent me records on the case. 23 Q. Have you done any work for Mr. Levinson 24 or his law firm in your consulting practice in 2 5 approximately the last ten years or since the Maliko RNW 2242 EPSTEIN - Direct/Ho 11ingshead 23 1 case ? 2 A. Unfortunately we seem to have drifted apart. 3 Q. So this is the first litigation you've 4 had with Mr. Levinson since the Maliko case? 5 A. Yes, correct. 6 Q. And that is also true of anybody else in 7 this firm, you have not had any professional contact 8 with them in the past ten years? 9 A. Correct. 10 Q. I supplied Mr. Levinson with, I believe 1 1 he sent to you a Notice To Take Deposition And 1 2 Produce Documents, and I believe you indicated 13 earlier that you have some materials here with you? 14 A . Correct. 15 Q. Let me mark this as an exhibit, if I 1 6 may, and we will see if we can figure out what you 17 bought in response to it. 1 8 (Notice To Take Deposition and Produce 19 Documents is received and marked Epstein 1 for 20 identification.) 2 1 Q. Dr. Epstein, I have marked as Exhibit 22 Epstein 1 the Notice To Take Deposition and Produce 23 Documents. Let me so show it to you. 24 A. I have it here, thank you. 2 5 Q. Can we just run through this and see RNW 2243 EPSTEIN - D1rect/Ho 11ingshead 24 1 what you might have in response to the six separate 2 categories that I have asked for? 3 A. Either that or I can tell you what I have, 4 whichever you prefer. 5 Q. I just need to know what might line up. 6 The first group of requests, which I 7 will paraphrase, was asking for records of 8 communications between yourself and Mr. Levinson or 9 his office, including all documents that are in 10 writing, obviously documents in writing that would 1 1 include correspondence, memoranda, notes, et cetera. 1 2 Do you have anything that would be in 13 particular response to that request? 1 4 A. Yes, I have his original letter to me of April 1 5 '88, all subsequent correspondence or documents that 1 6 he sent me I've incorporated in various sections of 17 this notebook which we can go through at a later 1 8 stage. 19 Q. Let me ask a broad question, Dr. 20 Epstein. Is there anything in that notebook that 2 1 either you or Mr. Levinson might consider to be 22 confidential or is it all available? 23 MR. LEVINSON: I don't think so. I 24 haven't looked at it yet, I might add, but I looked 25 at my correspondence in the office, there's nothing RNW 2244 EPSTEIN - Direct/Ho 111ngshead 1 there particularly. 25 2 Q. Is the original letter also included in 3 the notebook? 4 A. No . 5 Q. All right, why don't we put that there 6 and I will come back to marking it. 7 So anything in response to item or 8 request number one would be contained between the 9 letter and note? 1 0 A. And the note, yes. 1 1 Q. Would that also be true for all 1 2 materials supplied to you by Mr. Levinson's office? 1 3 A. Correct . 14 Q. And would the same be true for all 1 5 documents reflecting communications? 1 6 A. Correct. 17 Q. This might require some interpretation. 18 When this notice was written this was intended to 19 indicate persons other than Mr. Levinson or his law 20 f irm. 2 1 A. 22 Correct. Q. Have you had any such conversations with 2 3 anyone else regarding the subject matter of this 24 litigation other than Mr. Levinson? 2 5 A. Yes. RNW 2245 EPSTEIN - D1rect/Ho 11ingshead 26 1 2 A. Q. Who was that? Dr. Velez. 3 Q. And Is there anyone other than Dr. Velez 4 that you have spoken with in this litigation? 5 A. No . 6 Q. Have you spoken at all with Dr. 7 Davidson ? 8 A. No . 9 Q The communication with Dr, Velez , was 1 0 that initiated by him or by you? 11 A. There were two phone calls from him in October 1 2 o f this year, 13 Q. Do you recall the subject of each of the 1 4 phone calls? 15 A. Well, generally. The first one was on, I think 1 6 he asked me for my report or he had seen the report 17 and I had really forgotten -- let me see, yes, I 18 remember now, the second one was what he asked me for 19 the Tabershaw documents, he said he didn't have them 20 and I sent him a copy of the Tabershaw documents. 2 1 Q. The Tabershaw? 2 2 A. I beg your pardon, there's three. There's two 23 unpublished, one Tabershaw and Gaffey document, one 24 Tabershaw document and unpublished Tabershaw/Cooper, 2 5 and I will give you the references for those. RNW 2246 EPSTEIN - D1rect/Ho 111ngshead 27 1 Q. Did Dr. Velez Indicate in that 2 conversation why he was asking for the Tabershaw 3 documents ? * 4 A. He said he had seen in my report reference to 5 them but he didn't have them and asked if I could 6 send them to him. 7 Q. Did he tell you that approximately at 8 that period of time his deposition was being taken in 9 this case? 10 A . No . 1 1 Q. Are you -- 1 2 A. Excuse me. No, that's not true, excuse me. He 1 3 did tell me on the second conversation that he was 1 4 going to be deposed and he would like to review the 1 5 Tabershaw documents personally before that 16 deposition. 1 7 Q. Do you have any indication in writing, 1 8 perhaps in a diary or in any other writing as to when 19 those two phone calls were made? 20 A. No. I can tell you the second one was prior 2 1 to his deposition because I remember him saying to me 22 he felt he should review both of those documents, all 23 of those documents before his deposition. 24 Q. In the first conversation with him, is 2 5 it your recollection that in general he was only RNW 2247 EPSTEIN - Direct/Ho 11ingshead 28 1 asking for a copy of your report? 2 A. Correct, yes. 3 Either that or he perceived it and had a 4 question about it, I'm afraid I just can't recall. 5 Q. Did you make any notes regarding that 6 conversation? 7 A. No, I didn't make notes on the conversations. 8 Q. Did you make any notes on the second 9 conversation? 10 A . No . 1 1 Q. Did you discuss with him at all in 1 2 substance any of the Tabershaw documents? 13 A. No, he just asked me if I had them. He said 1 4 he was intrigued by them, could I send him copies. I 1 5 said, sure. 1 6 Q. Did he ask you during that conversation, 1 7 to your recollection, if you were aware of any 18 particular studies that would relate to polyvinyl 19 chloride with laryngeal cancer? 20 A. No, that discussion was just focused 2 1 exclusively on the Tabershaw documents. 2 2 Q. Did he ask you any questions with regard 23 to your view or opinion as to whether asbestos can 24 cause laryngeal cancer? 2 5 A. No, there was no other subject of discussion RNW 2248 EPSTEIN - D1rect/Ho 11ingshead 29 1 other than what I've stated. 2 Q. In your report. If I recall correctly 3 there is a Tabershaw document referred to, I thought 4 it was Tabershaw Cooper to my recollection? 5 A. I think there's more than one frankly. 6 Q. All right. 7 A. Let me just check. 8 Q. With regard to all of the documents that 9 you refer to in your report, you include them in your 1 0 reference, do you not, at the end of each section? I 1 1 recall that there's a section of references. 1 2 A. Yes, you will find actually two references, 1 3 actually there's one missing here -- No, no. 14 Q. You're looking at page 6 of your report? 1 5 A. Page 6, there's one missing there. There's a 1 6 Tabershaw and Gaffey published study and then the 17 supplementary Tabershaw/Cooper study, there was a 1 8 prior unpublished Tabershaw report in 1974 which is 1 9 basically very, very similar to the Tabershaw and 20 Gaffey published paper. 2 1 Q. You've indicated here that the Tabershaw 2 2 and Cooper report is an unpublished report in 1975? 2 3 A. Yes, but in addition to that -- 24 Q. There's another unpublished one? 2 5 A. Another unpublished one, which is very, very RNW 2249 EPSTEIN - Direct/Ho 11ingshead 30 1 close to the Tabershaw and Gaffey published report in 2 '74 and I gave all those three to Dr. Velez and I'm 3 pretty sure from when I read his depo that he gave 4 you copies of them. 5 Q. Is the Tabershaw and Gaffey report the 6 one published report? 7 A. 8 Yes. Q. That's the 1974 one, yes. That's the only one that's been 9 pub 1ished? 10 A. 11 Correct, to the best of my knowledge. Q. When Velez called you, is your 1 2 recollection that he asked you specifically for the 1 3 Tabershaw papers? 1 4 A. Yes, in the second discussion. 1 5 Q. We'll go back to the report later. 1 6 A. Sure. 17 Q. All right, we were talking about item 18 number three in the Notice To Take Deposition. Let's 1 9 move to item number four which would be with regards 20 to all materials which you have reviewed, consulted 2 1 or read and considered in reviewing this litigation 2 2 and the issue that was raised there and in rendering 2 3 their opinions. It's a very broad category but I 24 wonder if you have anything in the notebook that's 25 responsive to that? RNW 2250 EPSTEIN - Direct/Hoi1ingshead 31 1 A. Yes, you will find as you go on a wide range 2 of items which were responsive to that. 3 Q. Is it your testimony that the notebook 4 would contain all of the items that you would have 5 considered in rendering your report, including all 6 studies, et cetera? 7 A. I'm not willing to state all, but I mean I 8 have extensive background in these areas, but that 9 certainly wouldn't preclude me from saying I haven't 1 0 information on other matters. 1 1 Q. Are all the published materials that you 1 2 cite in your expert report in this case contained 1 3 within the notebook? 14 A. What do you mean all of them, the references 1 5 do you mean? 1 6 Q. Sure. 1 7 A. Yes. 1 8 Q. Just pointing one out, Newhouse & Berry, 19 the Lancet Volume II, I suppose that is Appendix 1 of 20 your report. If I were to look in your notebook, 2 1 would I find that? 2 2 A. No, what you would find is references to 2 3 everything I've read, and in many instances tables or 24 inferences drawn on those references but not the 25 original articles. RNW 2251 EPSTEIN Direct/Hollingshead 32 1 Q. That's what I need to know. Thank you. 2 The report that I have been referring 3 to, which we probably should mark, it is entitled 4 Preliminary Report with a date of 9/13/89? 5 A. Correct. 6 Q. Is it not? 7 A. Yes. 8 MR. HOLLINGSHEAD: Let me ask the 9 reporter to mark this Epstein 2. 10 (Preliminary Report is received and 1 1 marked Epstein 2 for identification.) 1 2 Q. Dr. Epstein, do you have a copy of your 13 preliminary report? 14 A. Ido. 1 5 Q. My question was that the Preliminary 1 6 Report has a dateof 9/13/89? 17 A. Yes. 1 8 Q. Did you ever provide a subsequent report 19 after this preliminary report in writing? 20 A. This morning I gave Mr. Levinson some 2 1 additional material dealing with areas which I felt I 2 2 hadn't adequately considered and which I felt needed 2 3 further work and, in fact, when I wrote the original 24 report I was under some time constraints, Mr. 25 Levinson said he needed something pretty quickly and RNW 2252 EPSTEIN - D1rect/Ho 11ingshead 33 1 I will be going over those materials with you today. 2 MR. HOLLINGSHEAD: Mr. Levinson, is it 3 your intention to provide me with the subsequent 4 report that you received this morning? 5 A. Excuse me, sir, I said I have these materials 6 with me, I will be giving them to you today. 7 Q. My question is: Have you written a 8 subsequent report? 9 A. Not a formal report. 10 Q. That's my question. 1 1 A. Let's go back. I haven't written a subsequent 1 2 formal report, but what I have done is prepared some 1 3 additional documents which will update that, but I 1 4 haven't entitled them subsequent formal report. 1 5 Q. Are they contained within your notebook 1 6 in a binder or some section of it? 1 7 A. Yes, all in this notebook. 18 Q. I'm a bit at a loss to determine where 19 to go, perhaps you should indicate to me what those 20 materials are. 2 1 A. Absolutely. There's basically three 2 2 documents. One entitled, just for the sake of 23 facilitating your further reference to these, there 24 in the first section entitled Summaries, okay? The 25 first is entitled, Factors Incriminating VC/PVC As RNW 2253 EPSTEIN - Direct/Ho 11ingshead 34 1 The Primary Cause Of Peterson's Laryngeal Cancer. 2 It's a one page sheet. 3 This is a bit out of sequence but it 4 doesn't matter, the second is. State Of The Art On 5 VC/PVC Toxicology Prior To 1974. 6 The third is Illustrative Literature On 7 The Toxic And Carcinogenic Effects Of VC/PVC In The 8 Respiratory Tract Of Expermental Animals. 9 The final one is Illustrative Literature 1 0 On The Toxic And Carcinogenic Effects Of VC/PVC In 1 1 The Respiratory Tract Of Exposed Workers. 1 2 Q. What caused you to prepare those, as I 1 3 heard you describe it, those four separate documents? 14 A. Basically, as I said, Mr. Levinson gave me 15 very short notice for the first document. I think he 1 6 called my office, I really don't recall exactly, 17 about a week or so before, he said I've got to have 18 something from you right away. I said I will do my 19 best and for this reason I wrote preliminary, 20 intending to go into further areas which I consider 2 1 to be of critical relevance to this case That's 2 2 basically what I did. 23 Q. Did you advise Mr. Levinson that you 24 intended to go into other areas at a later point in 2 5 t i me ? RNW 2254 EPSTEIN - Direct/Ho 11ingshead 35 1 A. Absolutely. He said, why is your report 2 preliminary? I said, look, you asked me at the last 3 minute, I've done my best but I intend to mesh this 4 thing out prior to my depo. 5 Q. Did you have a discussion with Mr. 6 Levinson when you returned from Europe sometime in 7 September, as I recall, do you recall that? 8 A. I would imagine so, I don't recall. 9 Q. Did you have a further discussion with 1 0 Mr. Levinson on the subject of a subsequent report or 1 1 series of documents as you've described? 1 2 A. At one stage shortly after I returned, I said, 13 look, I intend to work up some further aspects of 14 this case, and he said fine. He said, whatever you 15 do, either send it to me or bring it to the depo. 1 6 Q. Turn back to the first page if you 17 would, please. 18 A. Sure. 19 Q. I believe that first page is entitled 20 something with regard to Factors Incriminating VC/PVC 2 1 As The Primary Cause Of Peterson's Laryngeal Cancer? 2 2 A. Yes. 23 Q. What caused you to write that page after 24 your preliminary report which talks about a number of 25 chemicals? RNW 2255 EPSTEIN - D1rect/Ho 11ingshead 36 1 A. Well, basically, as I indicated before, the 2 initial report was preliminary. Another factor was 3 my reading of Davidson's depo which refreshed my 4 memory as to the specifics of the problems with the 5 PVC dust exposure, and after I read that I went back 6 to the original files and got into all details of the 7 extent and specifics of the exposure and it became 8 very clear to me that this exposure to PVC dust was 9 very prolonged and sustained and heavy and at that 10 stage I felt that I should dot the i's and cross the 1 1 t's, and while I'm not willing to exclude 1 2 contributory role of the wide range of his other 1 3 exposures, that I wanted to dot the i's and cross the 14 t's in relation to the specifics of VC/PVC exposure 15 and laryngeal cancer. 1 6 Q. When did you receive Dr. Davidson's 1 7 deposition? 18 A. I think I got it shortly after the depo, but 19 exactly when I don't know. But I didn't really read 20 it until after I got back from Europe, and at that 2 1 stage I decided to go back to the original file and 2 2 look up all the details on his exposure and these 2 3 were factors which influenced me to prepare this 24 additional material. 2 5 Q. When did you actually write the page RNW 2256 EPSTEIN - Direct/Hollingshead 37 1 that we're talking about, the one entitled Factors 2 Incriminating VC/PVC, et cetera? 3 A. Shortly after I got back I started going 4 through these materials and making notes on all of 5 this. 6 When I say all of this, I mean not just 7 this page but these other four exhibits, and I made 8 notes on an ongoing basis and I think that one of the 9 -- the one on the epidemiology or clinical studies 1 0 was finished about a week or so ago or two weeks ago, 1 1 so these have all been completed in the course of 1 2 over the last couple of weeks. 1 3 Q. At the time you prepared your 1 4 preliminary report, what was your understanding as to 1 5 Mr. Peterson's exposure to asbestos? 16 A. I knew that he had asbestos exposure, as 1 7 indeed I indicated in the report. 18 Q. Where had you learned that? 19 From which document did you learn that? 20 A. I learned that from two pieces of information. 2 1 One, from his X-ray which made it very 2 2 clear. He had an X-ray which made it clear he had 2 3 calcification of his diaphragmatic pleural and other 24 changes in the lungs which are pretty characteristic 25 of asbestos exposure. RNW 2257 EPSTEIN - Direct/HoIIingshead 38 1 Q. And which could only come from asbestos 2 exposure ? 3 A. In my view, yes. I'm not prepared to exclude 4 a contributory role in some of these from PVC dust, 5 but I would refer to Dr. Velez in this area as his 6 experience as the respiratory clinician, which I am 7 not. 8 And the second is a little time ago, I'm 9 afraid I can't say exactly when, I received a note 10 from Mr. Levinson's office documenting the fact that 1 1 he had asbestos exposure. 1 2 Q. Do you have that note somewhere in the 1 3 notebook? 1 4 A. No, the information in the report incorporates 1 5 the information that Mr. Levinson sent me on the 16 asbestos exposure. 17 Q. When you say you received a note from 18 Mr. Levinson or his office, was that in the form of a 19 letter? 20 A. No, it was one or two pages of additional 21 information on his occupational exposure. At one 2 2 stage I had Mr. Levinson -- Mr. Levinson sent me a 2 3 document or notes on his personal history and his 24 occuDational historv and than at a Tatar stacre. which E P ST EIN - Direct/Hollingshead 63 1 starting at the very beginning you talk about having 2 done a review of available documentation and records 3 of Mr. Peterson. 4 May I assume, based on what was just 5 gone through, that any of that documentation or 6 record of Mr. Peterson is referred to in some fashion 7 in the notebook? 8 A. Correct . 9 Q. Or atleast thenotebook contains your 10 summary of information that you obtained from medical 1 1 records supplied to you from Mr. Levinson? 1 2 A. Correct. 1 3 Q. You also indicate you reviewed the 1 4 relevant scientific literature. 15 With regard to any scientific literature 1 6 that you found to be relevant on the issue impacting 17 on Mr. Peterson's case, would I be correct in 18 assuming that you have referred to it in some fashion 19 in your preliminary report? 20 A. Yes. 21 Q. So thatif there isadditional 22 scientific literature that you have reviewed, but 23 have not included, that would indicate that in your 24 view it's not relevant to the Peterson matter? 25 A. I wouldn't say that. I'm not saying there may RNW 2283 EPSTEIN - Direct/HoIIingshead 64 1 not be other relative material which I haven't looked 2 at . 3 Q. Not a question of what you have not 4 looked at or not found, but if you had reviewed 5 anything that you considered to not be relevant, you 6 would not have included it, I presume, in the report; 7 is that correct? 8 A. If it wasn't relevant? 9 Q. Yes, if it was not relevant. 1 0 A. You're quite correct. 1 1 Q. And for anything that you reviewed and 1 2 was considered to you to be relevant, it would be 1 3 referred to in your report? 1 4 A. Yes. In other words, there may well be, in 15 fact, other references which are of importance which 16 I just haven't discussed, because you'll notice that 17 in the tables I talk about illustrative references, 18 so it's not meant to be a totally exhaustive complete 19 analysis of the total literature. 20 Q. When you get involved in a piece of 2 1 litigation and have to determine what the relevant 22 literature might be, how do you go about that? Do 2 3 you use some computer service? 24 A . No . 2 5 Q. Do you do your own personal research? RNW 2284 EPSTEIN - D1rect/Ho 11ingshead 65 1 A. I have my own files which I keep updated. 2 Q. Do you use Toxline or Medline or any of 3 those computer services? 4 A. Once in awhile I will, but I go through 5 journals on a regular basis and generally keep my 6 files up-to-date. 7 If, indeed, my files on any particular 8 subject are not complete, I might use Toxline or 9 Medline but in this case I didn't. 10 Q. How do you keep your own files? Do you 1 1 keep it by subject matter of chemical or substance or 1 2 injury or just how? 1 3 A. By chemical and, in fact, I bought you a 14 collection of my cards on VC/PVC. 1 5 Q. Is this a good example of how you keep 1 6 your own files? 17 A. Yes, that's typical. 18 Q. Now, these are index cards, three by 19 five index cards or thereabouts -- 20 A. Yes. 2 1 Q. -- That you have collected over the 2 2 course of time? 23 A . Yes. 24 Q. Would these three by five index cards 2 5 have an indication of when you added the cards to RNW 2285 EPSTEIN - Direct/Ho 11ingshead 1 your collection? 66 2 A. No , 3 Q. It wou1d simply have the name of the 4 author o f the study? 5 A. Precisely. 6 Q. And date of publication. 7 In summary fashion in this first 8 paragraph on page one. Dr. Epstein, you've indicated 9 that you have concluded that Mr. Peterson's 10 occupational exposures at ATC was causally related to 1 1 the laryngeal keratosis -- 1 2 A. Correct . 1 3 Q. -- He developed in 1978 and the laryngeal 14 cancer he subsequently developed in 1984. And the 15 sentence goes on so, but that's the part that I'm 16 interested in at the moment. 17 A. Yes . 18 Q. For my working definition, what is 19 keratosis? 20 A. A keratosis is a premalignant condition 2 1 involving hyperplasia, epithelial hyperplasia, and 2 2 generally characterized by atypical cells in the 23 mucosa. 24 Q. What is a hyperplasia? 25 A. It means an increase -- let me try to find the RNW 2286 EPSTEIN - Direct/Holiingshead 67 1 easiest way of explaining it. 2 It's a multiplicative reaction increase 3 in a number of cells, cell lining? Hyperplasia will 4 be one of the factors in keratosis. 5 Q. Is there something in the medical 6 records that indicates that he was diagnosed with 7 such a condition in 1978? 8 A. Yes . 9 Q. Do you have a recollection as to where 10 you obtained that information? 1 1 A. Medicalrecords. 1 2 Q. Was it the hospital records? 13 A. 14 Surely, yes. Q. Is the laryngeal keratosis a procurance 15 to laryngeal cancer? 16 A. Very often, yes . 17 Q Based on what you have reviewed in this 1 8 case , is it your view that the laryngeal keratosis in 1 9 Mr . Peterson 's situation was. in fact , a procurance 20 to a laryngeal cancer? 21 A. Yes , correct . 2 2 Q. When you talk about his, I quote here, 23 quote, "His occupational exposures at Amboy 24 Terminaling Company", which exposures in particular 2 5 are you referring to and did you mean to refer to at RNW 2287 EPSTEIN - Direct/Ho 11Ingshead 68 1 the time you wrote the preliminary report that's been 2 marked as the exhibit? 3 A. 4 one . You'll find these listed under section number 5 Q. Section number one is the section that 6 follows this paragraph? 7 A. It's the second paragraph, yes. 8 Q. It was your conclusion as expressed in 9 the first paragraph that all of these occupational 10 exposures combined in some fashion to be causally 1 1 related to the laryngeal keratosis and laryngeal 1 2 cancer ? 1 3 A. I didn't make any attempt to rank them, I just 1 4 said that his occupational exposures were causally 1 5 related to his laryngeal cancer and then in the next 1 6 paragraph I list what they are and then I also give 17 evidence for the toxicity and carcinogenicity in the 1 8 subsequent information, including their affect on the 19 larynx and respiratory tract. 20 Q. Just to be specific, throughout your 2 1 report you're talking about occupational exposures to 22 polyvinyl chloride, vinyl chloride, monomer, asbestos 23 polystyrene, Isopropi1idene resin, which you also 24 referred to earlier today as Bisphenol A, and also to 2 5 the emissions from welding fumes? RNW 2288 EPSTEIN - D1rect/Ho 11ingshead 69 1 A. You left out one or two but in principle 2 that's okay. 3 Q. If I have -- 4 A. Epich1orohydr in for instance. 5 Q. Epichlorohydrin, if I recall your 6 report, you indicate the Epichiorohydr in came from 7 the Isopropi1idene resin? 8 A. Yes. 9 Q. So I meant to include that. 10 A. I'm sorry, I beg your pardon. 11' Q. Is there another that I left out? 1 2 A. Well, the welding fumes and the -- 13 14 A. Q. I said that. You did? I'm sorry, and the heat sealing 15 fumes. 1 6 Q. The heat sealing fumes would be as I 1 7 again read your report, the degradation of a PVC 18 resin? 19 A. Degradations of anyresins. 20 Q. Correct. Polystyrene? 21 A. Correct, yes. 22 Q. Would that then cover the gamit of all 23 of the occupational exposures you were aware of at 24 the time you wrote the report? 25 A . Yes . RNW 2289 EPSTEIN - Direct/Ho 11ingshead 70 1 Q. Since you wrote this report, are you 2 aware of any other occupational exposures that Mr. 3 Peterson had at ATC? 4 A. I don't think so, no. 5 Q. Is it your opinion that those 6 occupational exposures, all of them that we have just 7 listed, to be combined in some fashion to cause Mr. 8 Peterson's laryngeal keratosis and his subsequent 9 laryngeal cancer? 10 A. They all had a -- it's not possible to exclude 1 1 a causal role or contributory role of any of these 1 2 exposures. 13 In other words, all of these had 14 carcinogenic affects on the respiratory tract and/or 1 5 irritant affects on the respiratory tract, the 1 6 importance of some of them more important than 17 others, but it's not possible to exclude a 18 contributory role of any of these individual 19 exposures. 20 Q. What do you define as the respiratory 2 1 tract, if you can tell me everything that would 22 constitute a respiratory tract? 2 3 A. It starts from the nose, goes all the way down 24 to the terminal alveoli. 25 Q. That's at the base of the lungs. I'm RNW 2290 EPSTEIN - Direct/HoiIIngshead 71 1 not a physician so I may misstate it, but it's in the 2 lung area, is it not? 3 A. Yes. 4 Q. What would it include between those two 5 end points? 6 A. Includes the nose, nasopharynx, pharynx, 7 larynx, trachea, bronchi, bronchials, alveoli and 8 pleura. 9 Q. Are all of the individual exposures that 10 you have listed, if you took each of them separately, 1 1 is each of them a carcinogen? 1 2 A. Well, I have given you the specific of each of 13 these. 14 Q. In your Appendix 2? 1 5 A. In the appendix. First of all, for each of 16 the*major categories in Appendix 1, there is a 1 7 description of each of them and data on their 1 8 carcinogenicity and that's under Appendix 1 in which 19 it deals with each of these major exposures; and then 20 there's a brief summary table in Appendix 2. 2 1 Q. Well, referring to either one of them or 2 2 both of those appendices, if you wish, let me just 2 3 ask a simple question again, as to whether or not in 24 your opinion each of those occupational exposures 25 that Mr. Peterson had was to a carcinogen? RNW 2291 EPSTEIN - Direct/Ho 11ingshead 72 1 A. Yes or to a group of carcinogens. 2 Q. Well, I'm breaking them down. If I took 3 each Individual exposure, each of them would be a 4 carcinogen, I'm trying to stay away from a 5 careinogistic affect at the moment. 6 A. I understand, but when you come to something 7 like the welding, there's groups of carcinogens there 8 and the other point that I wanted to make was in some 9 instances in addition to the carcinogenic affect of 1 0 some of these exposures, there's a chronic toxic or 1 1 chronic irritant affect which is discussed under each 1 2 exposure under Appendix 1. Is that responsive? 13 Q. Sufficiently so. 1 4 A. Okay. 15 Q. What information do you have. Dr. 16 Epstein, as to Mr. Peterson's specific exposure to 17 PVC resins and the result of VCM fumes from that? 18 A. This is listed in great detail in the section 19 marked OH, occupational history. 20 Q. Which I have not seen before today so I 2 1 wouldn't know that. 2 2 A. Fine. So let me go over this and also the 23 other. In addition, it's listed with even greater 24 specificity under the heading ATC, okay? So as far 25 as the PVC resins are concerned, there's three major RNW 2292 EPSTEIN - Direct/Hollingshead 73 1 -- well, first of all, let me start further and talk 2 about the PVC/VC resins at ATC. 3 The amounts of these resins that were 4 received were the resins that arrived at ATC, from 5 ETC in 50,000 pound van containers. 6 Q. Excuse me, what is ETC? 7 A. ATC, I beg your pardon. It arrived at ATC, 8 Amboy Terminaling Company from UC, from Union Carbide 9 in 50,000 pound van containers and also in smaller 1 0 van boxes and the total shipments were about one and 1 1 a half million pounds a day or four-hundred million 12 pounds a year. 13 Q. Let me stop you. Dr. Epstein, at the 14 risk of being slightly rude. 15 My question was, what specific exposures 16 did Mr. Peterson have, not to the amounts of material 1 7 shipped to ATC. 18 A. Okay, fine. I believe this is important 19 background. I am going to come to the specifics of 20 that because what I wanted to do is to give an 2 1 overall indication as to the amount of resins handled 2 2 at ATC by which Mr. Peterson's exposure would be a 23 subset of that, so I was leading to that. If you 24 just allow me to complete just 30 seconds more and I 25 will get onto the specifics, if I may. RNW 2293 EPSTEIN - Direct/Hollingshead 74 1 So in other words, the total shipments 2 there were about one and a half million pounds a day 3 or four-hundred million pounds a year at about 350 to 4 400 bags an hour were processed. 5 Now, as far as the PVC resins are 6 concerned, we have to first of all discuss what 7 resins he was exposed to. 8 There were three kinds of resins which 9 were handled at ATC; the suspension; the bulk; and 1 0 solution, and from '60 to '75, somewhere in the 1 1 region of 30 percent of all the resins were 1 2 suspension according to the records. 13 This is an interesting contrast to Dr. 14 Wheeler's statement that '85 percent of all U.S. 15 production was, in fact, suspension. 1 6 Be that as it is may, from before '75, 17 according to Dr. Wheeler, the levels of the VC in the 1 8 PVC were 860 ppm, although in his interrogatory he 19 gives different figures. He says goes up to 2000 20 ppm, and there's other indications that they go up to 2 1 3,700 ppm. And after '75, the levels of the VC and 22 the suspension resin were reduced and probably less 23 than about 100 ppm. 24 The bulk resins which had lower VC 25 levels and solution levels, solution resins. RNW 2294 EPSTEIN - Direct/Hollingshead 1 As far as the PVC dust levels are 75 2 concerned, all I can say is ATC and UC failed to 3 monitor the air area so there's no available data on 4 the levels of PVC. 5 Q. Let me hold you right there. Have you 6 seen the Gollob laboratory reports indicating the 7 levels of work space contamination? 8 A. Levels of what? Which are we talking about? 9 Q. VCM. 1 0 A. I wasn't discussing the VCM, I was discussing 1 1 PVC . 1 2 Q. Are you aware of the Gollob results? 13 A. Yes. 14 Q. Were the Gollob laboratory reports 1 5 provided to you? 16 A . Yes. 17 Q. Do you have them back in your office? 18 A. I think I do, yes. I think I kept the Gollob 19 report, I don't recall any data on PVC dust levels. 20 Q. Do you recall what the Gollob laboratory 2 1 reports did show? 2 2 A. Yes, VC, but I wasn't discussing VC, I was 2 3 discussing PVC. I will come to the VC if you allow 2 4 me t o comp1e t e. 25 Q Yes . RNW 2295 EPSTEIN - Direct/Hollingshead 76 1 A. As far as the PVC dust levels, it's my 2 understanding there were no data on PVC dust levels 3 in the ATC Plant. 4 Q. You're talking about airborne? 5 A. Correct. 6 Q. Pardon me if extremely long narrative 7 requires me to do that. 8 A. Please do. Please interrupt. 9 Q. You are talking about airborne dust? 10 A. Yes. Airborne dust levels, yes. 1 1 We do, however, have some, according to 1 2 Wagoner, the levels of PVC dust are highest in the 13 bagging areas. We also have some data from NIOSH. 14 Q. Excuse me, let me back up. 1 5 What information do you have from Dr. 1 6 Wagoner ? 17 A. That's a Wagoner publication which I refer to. 18 Wagoner, et al 1980. 19 Q. It deals specifically with ATC levels in 20 the bagging area? 2 1 A. I already said there is no data. I've already 22 said there's no data on PVC dust levels in the ATC 23 plant, so the Wagoner report, in general, the levels 24 are highest in bagging areas, not specifically ATC. 25 And so that's basically all our data on PVC dust RNW 2296 EPSTEIN - Direct/Ho11ingshead 77 1 levels which is non-existent as far as ATC is 2 concerned. 3 In coming to the atmospheric levels of 4 vinyl chloride, let us discuss them under the 5 following headings. First of all, the sources of 6 vinyl chloride, then the data for prior to '75, the 7 air level data prior to '75, and then the data in 8 ' 76 . 9 Q. Dr. Epstein, I'm going to stop you there 1 0 because this has gone on at some length now. I don't 1 1 think it's responsive to my initial question, which 1 2 is the specific levels of exposure that Mr. Peterson 1 3 had to either PVC or VCM, the cause of PVC. 14 Let me see if I can shortcut this a 15 bit. 1 6 For the record, I will indicate that 17 you've been referring to the sheet marked ATC that 18 appears in the notebook, and therefore, I'm sure that 19 all of this information can be found there? 20 A. Sure. 2 1 Q. Do you have any information that would 22 allow you to conclude on a parts per million basis 23 how much exposure Mr. Peterson had, let's take on an 24 average workday at ATC to either PVC or VCM? 25 A. Well, first of all, we don't have any RNW 2297 EPSTEIN - Direct/Hoi 1ingshead 78 1 monitoring specifically for Peterson, so all the 2 information has to be inferential and this 3 information is derived from two sources. 4 First of all, description of the work 5 conditions, which I will go through with you first; 6 and then I will go through with you, if you so wish, 7 the information on the monitoring levels in the area 8 he worked in from which one can withdraw inferences 9 on his exposure. 10 Q. Well, let's work backwards, if we can. 1 1 Why don't you give me the bottom line in 1 2 your opinion as to what the exposure level was for 1 3 Mr. Peterson and then we can work back as to how you 14 determined that. 1 5 A. As far as the PVC dust levels are concerned, 1 6 and these were very high dust levels indeed, that's 17 based on the description of his work conditions and 1 8 and the statements, his description of work 19 conditions, but also what I know from the Maliko case 20 and what we also know from the Davidson report. And, 2 1 in fact, you will find this specified in detail in 2 2 the section in the notes marked Factors Incriminating 2 3 VC/PVC, which I state he was continually exposed to 24 very high levels of PVC dust with high concentrations 2 5 of residual VC from 1967 to '73. That was the first RNW 2298 EPSTEIN - Direct/HoIIingshead 79 1 point. 2 Then he was continually exposed to -- 3 shall we stay with PVC or? 4 Q. I don't mind going back- and forth 5 provided we have an indication of when we talk about 6 which. 7 Hold that statement for a moment, if you 8 would? 9 A. Sure. 10 Q. You indicated from that, the dust levels 1 1 from PVC I think you said were high, very high. When 1 2 you use the phrase very high, if you would place it 13 in terms of parts per million, what number would you 14 put it at? 15 A. Well, you don't express dust levels in terms 1 6 of parts per million. I don't know, you generally 1 7 express them in milligram cubic meter. 1 8 Q. All right, let's use that. 1 9 A. I would say they're certainly in the high 20 milligram cubic meter over 20, perhaps in the 20 2 1 milligram per cubic meter range, in excess of that 2 2 the fact is that his hair, his clothing was covered 2 3 in white dust and he used to gag, so clearly they 24 were very high levels of PVC in the dust in the area 2 5 where he was working. RNW 2299 EPSTEIN - Direct/Ho 11ingshead 80 1 It's difficult, if not impossible, to 2 give you a precise figure on this or even a general 3 figure on this because of the failure of Union 4 Carbide and ATC to do any monitoring of the dust even 5 in spite of the very substantial literature going 6 back to the forties on the toxicity of PVC dust, so I 7 can't give you an answer to that unless indeed 8 there's unpublished ATC/UC literature on this. 9 Q. Is it your understanding that the dust 1 0 that Mr. Peterson was exposed to, the PVC dust was in 1 1 the respirable range? 1 2 A. Some was respirable and some was not. 13 Q. Do you know what percent of each was 14 respirable and was not? 1 5 A. I would say in general and, in fact, I 16 discussed this in some detail in here, as far as the 17 levels of concern, there is a conflict of data on 1 8 this . 19 Dr. Wheeler maintains levels of the dust 20 was 50 to 150 micron; however, Dr. Davidson did some 2 1 analytic work and found that the levels go down to 2 2 five micron, which is the bulk were in the range of 23 50 to 60 micron, but they go down to five micron. 24 But I would also emphasize that the impression of 25 respirabi1ity is relevance to lung pathology but not RNW 2300 EPSTEIN - Direct/Hollingshead 81 1 relevance in relation to laryngeal pathology. 2 Q. Why is that ? 3 A. Because large particles will reach the larynx, 4 it's only the large particles which will be filtered 5 out or stopped before reaching into the small bronchi 6 and bronchi elements, the question of respirabi1ity 7 of less relevance, if indeed any relevance in 8 relation to laryngeal cancer. 9 Q. Is that because in your view it's 10 important to note the amount of PVC dust that came to 1 1 actual physical contact with the larynx? 1 2 A. Well, obviously every breath he took he would 13 breathe in material that was in the air and this 14 would be progressively filtered out as it goes, as it 1 5 reached down into the lower respiratory tract and 1 6 upper large particles would impact and particles over 17 ten microns would certainly impact, but as you go 18 down into the depth of the lung you would have to 19 reach, you would only have to consider the respirable 20 size particles, that's a less than ten micron, if 2 1 you're considering pathology in the terminal lung. 2 2 Q. Doctor, you're not being responsive to 23 my question. Is it because what you're concerned 24 with determined how much of the PVC dust was in 25 contact with the physical larynx, is that what you're RNW 2301 EPSTEIN - Direct/Ho 11ingshead 82 1 looking for? 2 A. I would say everything he would breathe in in 3 the air would reach the larynx, yes. 4 Q. And some of it would be passed on 5 depending on its size? 6 A. Sure, other smaller particles would certainly 7 go down to the lung, particles under ten microns and 8 certainly the five micron. 9 Q. You're not suggesting that the remainder 1 0 would remain in contact with the larynx? 1 1 A. I'm not suggesting; stating the large 1 2 particles would impact the larynx and 13 laryngeal-pharyngeal area. 14 Q. What would happen to those particles 1 5 that would contact the larynx? 1 6 A. The VC, vinyl chloride in the PVC dust would 1 7 be deluted and produce loal (phonetic) affect on the 1 8 larynx in the larynx-pharyngeal area. 1 9 Q. As you say you allotted those VCM fumes, 20 what would happen to the resin particle, it would 2 1 pass through the system? 2 2 A. The particle could remain there for sometime, 23 it could be coughed up and disposed of in that way. 24 Q. Would that be the only way that the body 2 5 has to dispose of that particle? RNW 2302 EPSTEIN - Direct/Hollingshead 83 1 A. No, not at all. In addition to being coughed 2 up, I think some of them could be swallowed and pass 3 through the digestive system. 4 Q. Now, you've given me an approximate 5 number in terms of the milligrams per, what is it 6 cubic meter ? 7 A. Cubic meter,, all I can say is the air was 8 very dusty, the conditions were described as terrible 9 and the language that he used is self-explanatory, 10 terrible and very dusty, hair on skin and clothing 1 1 was covered with white dust. I cannot tell you what 1 2 levels were, but I would say they were in the high 1 3 milligram cubic meter range. 1 4 Q. Which you earlier have stated to me 1 5 would be somewhere in the 20 milligram per cubic 1 6 meter area? 1 7 A. I would say minimally, because we do know in a 1 8 PVC fabricating plant they would reach 20 milligram 19 per cubic meter, I would not be surprised if they 20 were in the 100 cubic area, but I have no idea 2 1 because I'm unaware of any monitoring data. 2 2 Q. In fact, you also have no idea whether 2 3 or not they were 20 milligrams per cubic meter from 24 any data? 25 A. That's not correct. Indeed PVC fabricating RNW 2303 EPSTEIN - D1rect/Ho 11ingshead 84 1 plant you would have levels going up to 90 milligrams 2 per cubic meter in an area where PVC dust was bagged, 3 one could say minimally it would be in excess of 4 that . 5 Q. So it's your testimony now that Mr. 6 Peterson was exposed to PVC dust in the range of 7 approximately 20 milligrams per cubic meter or is it 8 your testimony that it was higher? 9 A. My testimony is that we cannot give any 10 estimate on this because of ATC and Union Carbide's 11 failure to monitor, in spite of long standing 1 2 knowledge of the state of the art and toxicology 13 going back to the forties. That's number one. 14 Number two, if PVC fabricating plant 1 5 levels could reach 20 milligrams per cubic meter in 1 6 this plant where it was bagging, where conditions 17 were quote "terrible and very dusty" where his skin 18 and clothing were bad, minimally it would be 20 19 milligrams. I don't know, it could be 100 20 milligrams, it could be more, we don't know. 2 1 Q. I will move to have the first portion of 22 the witness' answer stricken as unresponsive to the 2 3 quest ion. 24 If we look at the exposure to vinyl 25 chloride monomer, VCM? RNW 2304 EPSTEIN - Direct/Ho 11ingshead 85 A. Yes . Q. Do you have any ability to determine with some specificity as to what Mr. Peterson's exposure was to VCM on an average workday at Amboy Terminaling Company? We may have to divide it into time 7 periods. 8 A. Sure. 9 Q. Let's take perhaps from 1967 to 1974; is 10 that a good time? 11 A. Or 175. 1 2 Q. All right, before '74/'75? 13 A. Okay, I would like to, without trying to be 14 totally responsive to your question, before I answer 1 5 that I have to specify what the particular source is 16 of VC because you have to consider a wide range of 17 different sources of exposure. 18 Q. I'm not sure I understand. Why don't 19 you tell me what it is? How do you want to answer 20 it? I will see if that's going to be a problem. 2 1 A. Fine. 2 2 We have to consider a wide range of 23 different ways and sources of vinyl chloride exposure 24 and attempt, as far as possible, to see what data 25 there are relating to each of these. There may be RNW 2305 EPSTEIN - Direct/Ho 11Ingshead 1 data, there are data relating to some of these 86 2 sources of exposure, but no data relating to other 3 sources of exposure; therefore, I'm not prepared to 4 give you an overall figure. 5 What I will do is I will tell you what 6 were the particular ways in which he was exposed to 7 VC and for some of these I will attempt -- I will 8 summarize the existing information on what these 9 1eveIs are. 10 1 1 A. Q. Let's start with that approach. Okay. 1 2 The other point I would also make is 1 3 that it is my view, and as I have stated in the 14 documentation, that the level, that the PVC dust 1 5 levels are of much greater importance in relation to 1 6 his laryngeal cancer than the vinyl chloride levels. 17 Q. Why is that? 18 A. The evidence for that you will find summarized 19 in the section marked Illustrative Literature On The 20 Toxic And Carcinogenic Effects of VC/PVC -- 21 Q. That's a document I have not seen before 2 2 today. 23 A. -- Where you will find several studies dealing 24 with PVC dust in which it's emphasized that the PVC 25 dust is a particularly important simulation to RNW 2306 EPSTEIN - Direct/Hoi1ingshead 87 1 respiratory tract cancers and let me just now point 2 you in the direction of two or three of them, then I 3 will get back to the original question. 4 First of all, you will find a whole 5 series of studies on PVC dust demonstrating 6 respiratory tract pathology including cancer. Then in 7 the paper by Wagoner & Infante, in their review they 8 conclude that PVC dust showed a significant 9 association with the respiratory cancers. 10 Waxweiler also says, "'PVC dust 1 1 appeared to be the most likely etiologic agent -- No 1 2 relationship (exists) between VC (air levels) and 13 lung cancer', probably due to its rapid absorption 14 into blood. And they emphasized the role slow 15 elution VC from trapped PVC particles in the lung." 16 Wagoner in '83 says the same thing, 17 "Emphasized carcinogenic role slow elution VC from 18 trapped dust particulates in lung." 19 So in other words, the literature makes 20 it very clear in that when you're dealing with lung 2 1 cancer in relation to PVC/VC, it's the PVC dust 2 2 levels in the PVC dust which is of much greater 23 importance than the VC, but let me now be more 24 responsive to your question as to the VC levels, 2 5 having already stated that it's the role of the PVC RNW 2307 EPSTEIN - Direct/HoIIingshead 88 1 dust which is the far greater importance than the VC, 2 nevertheless -- 3 Q. Pause one second. 4 A. Then we're going to discuss three things, 5 sources of the vinyl chloride, then vinyl chloride 6 levels prior to '75, and vinyl chloride levels after 7 ' 75 . 8 Before getting into this I should refer 9 you also to the Union Carbide Monitoring Report of 10 1974 which talks about high VC air levels from PVC 1 1 resins, okay? 1 2 Q. Which monitoring report is that? 13 A. The one which I referred to? 14 Q. The paper that talked about monitoring? 1 5 A. The Union Carbide 1974 report on Monitoring. 1 6 The Concentration Of Vinyl Chloride. 17 Q. Fine. 18 A. Okay, now the sources of VC are as follows: 19 First of all, VC absorbed on the resin itself, the 20 surface of the resin; secondly, the VC, the high 2 1 concentrations in storage areas, bins, bags, hopper 2 2 cars which is stated in the UC Monitoring Report of 2 3 1974, and in the Gollob report of 1974, there's 24 references to 1400 ppm in the van. 25 Q. In the van? RNW 2308 EPSTEIN - Direct/HoIIingshead 89 1 A. In the van, yes. 2 Q. Excuse me, do you have any indication 3 that Mr. Peterson was ever in the van? 4 A. We're not discussing that testimony, what I 5 said -- 6 Q. Well, one of the nice things about being 7 a lawyer is I get to ask the questions. 8 A. Excuse me, sir, you asked me the sources, we 9 were discussing sources. I'm going to come on to -- 10 Q. Yes, sir, and as I said earlier, it 1 1 sometimes becomes very difficult if you allow an 1 2 answer to go on at the length it is without asking a 1 3 question at the appropriate time, so since I referred 14 to the van, may I simply ask -- 1 5 A. No, I have no information that he was ever in 1 6 the van. 1 7 Q . Thank you. 18 A. I'm giving you, what I'm now listing are the 19 sources of the VC without any reference to the 20 specifics of his exposure, but we will come back to 2 1 that after I've listed all the sources of the VC for 2 2 you . 23 24 A. Q. Go ahead. The third is degassing of VC from pellets and 25 powder and also degassing of VC from PVC dust on his RNW 2309 EPSTEIN - D1rect/Ho 11ingshead 90 1 clothes, on his skin and in his body in either the 2 larynx or in the lung. 3 The next is displacement of air in the 4 50 pound bags as PVC was pushed into these bags air 5 would be displaced and air contaminated with VC is 6 displaced. 7 The next, fixed point emission sources. 8 Q. I don't understand that. Would you tell 9 me what that is? 10 A. In other words, at each of the area points 1 1 where the bags were filled, these are what you call a 1 2 fixed point emission source where the dust was, where 1 3 the PVC pellets were coming down the dust was coming 14 down from each of these areas, and finally, from 1 5 pyrolysis or thermal degradation from two sources, 1 6 from the heat sealer and from welding. 17 Okay, now, those are all the sources of 1 8 vinyl chloride to which exposure is possible, 19 although, as you correctly point out Peterson would 20 not have been exposed to some of these such as the 2 1 ones in the bag. 2 2 Now, let us review briefly the data, 23 what available data there are on VC levels prior to 24 ' 75 . 25 The most important point to be made is RNW 2310 EPSTEIN - D1rect/Ho 111ngshead 91 1 there were no sampling data prior to 1974. In spite 2 of the overwhelming literature on the toxicology and 3 carcinogenesis of VC, both UC and ATC failed to 4 sample the air prior to 1974, so therefore we have no 5 information on air levels of VC prior to '74. 6 Q. Let me interrupt you there. What was 7 the date of the Gollob laboratory air sampling that 8 was done? 9 A. ' 74 . 10 1 1 A. Q. In '74? Correct . 1 2 Q. Are you aware of any differences in the 1 3 ATC handling or processing of the resins that would 1 4 account for a higher VC level prior to '74 or the 1 5 date of the Gollob sampling tests? 1 6 A. First of all, I haven't addressed myself to 1 7 that, but secondly, we don't have data on -- we do 1 8 know that some of the earlier resins had higher VC 19 levels than the later resins, so it may well be that 20 there were higher VC levels in PVC prior to '74, I 2 1 just don't know. 22 We do have other data showing that. For 23 instance, there's a Morgan and Tacquard reference 24 showing that VC levels extend up to 3,700 ppm, so I 2 5 can't answer you on that. RNW 2311 EPSTEIN - D1rect/Ho 111ngshead 92 1 Q. Well, just so the record is clear, 2 that's a study that has nothing to do with ATC, it's 3 a general study. 4 A. It has everything to do with ATC because in 5 indeed the industry was manufacturing PVC resins with 6 much higher VC levels, it's unlikely that Union 7 Carbide would be any exception to that. 8 Q. Are you aware of whether Union Carbide 9 was or was not an exception to that? 10 A. I don't know. 1 1 Q. Do you know the manufacturing process 1 2 that Union Carbide used that -- 1 3 A. I can't answer that. All I know is that there 14 was no sampling data prior to '74, number one; number 1 5 two, that resins prior to '74 had much higher 16 1eve 1s. 17 I'm not talking about actually at the 1 8 time when the process design change was made, but I'm 19 talking about the earlier production that productions 20 of PVC could well have had higher VC levels, I don't 2 1 know the answer to that. 2 2 Q. In general, what is your understanding 2 3 as to what changed in 1974 to account for lower 24 levels of VC? 2 5 A. Well, belatedly Union Carbide introduced a RNW 2312 EPSTEIN - Direct/HoIIingshead 93 1 vacuum stripping technology to reduce the levels of 2 residual VC in the PVC, Union Carbide, as I indicated 3 before, had extensive knowledge of high levels of VC 4 in PVC prior to that, but delayed doing so until 5 after the B.F. Goodrich announcement of the 6 angiosarcoma deaths and also the OSHA emergency 7 temporary standard, so this was subsequent to those 8 events. So moving on from the statement that there 9 was no data prior to '74, we have to see what 10 available data there are subsequent to '74. 1 1 Now, Wheeler's simulation -- I beg your 1 2 pardon. Dr. Wheeler's simulation in modeling started 1 3 of claims that there were levels 0.98 ppm during 14 bagging. This is in contrast to Dr. Davidson's 1 5 estimate of up to one order of magnitude higher; in 16 other words, up to about ten -- 17 Q. Approximately double? 1 8 A. No, order of magnitude is ten fold of about 19 ten parts per million. 20 The Gollob analitycal data are as 2 1 follows: -- We're going to briefly review Gollob 22 analitycal data. 2 3 First of all, there are the irrelevant 24 data as Mr. Hollingshead has pointed out of the 1400 25 parts per million levels in a van. Then there's RNW 2313 EPSTEIN - D1rect/Ho 11ingshead 94 1 Gollob's data on three to four parts per million in 2 the breathing zone for the bagging, three to four 3 parts per million in the breathing zone in the bag 4 room, and then there's the irrelevant data on 27 5 parts per million between the pallets in the 6 warehouse where he didn't work, but these data ignore 7 the following. 8 They ignore the role, first of all, of 9 PVC dust, which we've already discussed in some 1 0 detail, which has maximal relevance to the 1 1 respiratory tract cancers. 1 2 It ignores the levels near the heat 13 sealer where periodically during heat sealing you can 14 have very high levels of exposure, and it also 1 5 ignores levels from welding where during welding you 1 6 could have sudden high levels. 17 It also ignores, of course, the role of 1 8 a wide range of co-po1lutants, the styrene and ozone, 19 et cetera, which could have an interactive, or as you 20 previously recognized, synergistic affect with the 2 1 PVC with the VC. After '75 and '76, Gollob 2 2 analytical data still finds more than one half of 23 part per million in the bag room, but this again 24 excludes the following: It excludes PVC dust, it 25 excludes VC from welding and from sealing and from RNW 2314 EPSTEIN - Direct/HoiIingshead 95 1 the sealer exposures which according to Davidson were 2 very high. That is the brief summary of the VC 3 levels. 4 Q. And I take it that brings us to the end 5 of your preliminary comments as you are leading up to 6 my original question which was, what were the VC 7 levels of exposure that Mr. Peterson had? 8 A. That's correct. 9 Q. Good, that sounds like a good time for a 1 0 lunch break. 11 A. Great. 1 2 (whereupon, a lunchrecessis taken. 1 3 Time noted 1:00 p.m.) 14 AFTERNOON SESSION. 15 (Time noted: 1:30 p.m.) 1 6 Q. Dr. Epstein, we're now back after the 1 7 break and we will pick up with my question as to what 18 were the VC levels of exposure that Mr. Peterson had 19 while he was employed at ATC? 20 A. Again, I have still onemoregeneral thing, 2 1 namely the source, the degassing of the VC from PVC, 2 2 and to be specific in the answer, I have to go 23 through in the same way as I've just gone through the 24 data on atmospheric VC levels. I have to tell you 25 what my position is on the VC exposures as a result RNW 2315 EPSTEIN - Direct/Ho 11ingshead 96 1 of degassing from PVC and the major types. 2 The first is VC will degas from PVC in 3 the following ways: The residual or the sources of 4 VC, the residual VC from the suspension resins, we've 5 talked about the Wheeler data of 860 parts per 6 million VC residual in suspension resins at Union 7 Carbide, and about a week later about 565 parts per 8 million. 9 Davidson emphasizes that the degassing 10 is non-linear, so it's very rapid then flatens off 1 1 subsequently. That's the first thing. 1 2 Now, the degassing of VC from PVC dust 13 would occur from PVC dust in the air and on his 1 4 clothing and on his skin. Gollob points out that 1 5 degassing is continual and the exposure is 1 6 continuing. Additionally there's likely to be very 17 high loal concentrations of vinyl chloride in the 1 8 body from very rapid elution in the body. 19 Q. When you say the body, what do you mean 20 by the body? 2 1 A. 22 Either lungs or larynx. In other words, if you have a PVC 23 particle or agglomerate, the VC would be eluted from 24 it rapidly producing very high loal concentrations of 25 vinyl chloride. RNW 2316 EPSTEIN - Direct/Hollingshead 97 1 Additionally, you will have very high 2 levels of VC reaching the hundreds part per million 3 from thermal degradation. So when you ask me what 4 are the levels of VC exposure, I can say it's 5 impossible to give you an overall figure because of 6 these very wide range of sources each without 7 characteristic types of exposure. 8 One can talk about what the levels in 9 the bagging area, the breathing into the bagging area 1 0 are, but this will give you no indication whatsoever 1 1 as to the VC levels from degassing air on his 12 clothing, from degassing from elution in the body of 13 PVC particles and also the massively high levels, 14 loal levels from heating, from thermal degradation in 15 relation to the sealer and the welder. 16 So the answer is a very wide range of 17 levels of VC going up to the hundreds of parts per 18 million and going down to levels which are found to 19 have been recorded in the bagging room, the bagging 20 area of the bagging room which I should point out is 2 1 some 50 foot away and the sealers are some fifteen 22 feet away from the baggers. 23 Q. What is your understanding of how Gollob 24 went about performing their tests in 1974? 25 A. That data were largely on breathing zones of RNW 2317 EPSTEIN - D1rect/Ho 11Ingshead 98 1 the baggers. 2 Q. How do they accomplish that? 3 A. Personal sampling. 4 Q. Personal sampling by way of a personal 5 monitoring? 6 A. Yes. My understanding is they also did some 7 area monitoring, too. 8 Q. Stay with the personal monitoring for a 9 moment. 10 That would be a personal monitor placed 11 upon the bagging operator? 1 2 A. Yes, correct. 1 3 Q. For how long a period did they have it 14 on the operator, do you know? 1 5 A. I forget. You can get those details from 1 6 Davidson or refreshing your memory in the report. 17 Q. Did you take into account the Gollob 1 8 personal monitoring results in the rendering of your 19 report? 20 A. It's one additional piece of information which 2 1 is of some help, clearly it's not directly relevant 22 to Peterson because he wasn't a bagger and therefore 23 it wouldn't be directly relevant, but in view of a 24 failure of UC and ATC to do area sampling and area 25 monitoring and monitoring of Peterson himself, one RNW 2318 EPSTEIN - Direct/Ho 11Ingshead 99 1 has to take a look at all available information, some 2 of which is more relevant, some which is less 3 relevant than others. 4 Q. What is your understanding of what Mr. 5 Peterson's position was at ATC? 6 A. Well, I thought we had discussed that, but I 7 can briefly go over it again. 8 Q. I want an answer to the question in 9 terms of what you understood his position to have 10 been . 1 1 A. From what period of time are you talking 1 2 about ? 13 Q. Prior to the 1974 period. 1 4 A. He was a maintenance and repair mechanic. 1 5 Q. What was his position after '74? 1 6 A. Maintenance supervisor. 17 Q. Based on what you know about the ATC 1 8 operation, due to your review of a considerable 19 amount of information, were the concentration levels 20 of VCM in the atmosphere likely to have been the 2 1 highest on an average basis in the bagging operation 22 or elsewhere? 23 A. Well, you have to define, with due respect, 24 your question more clearly because the levels in the 25 bagging area one can discuss or one can look at the RNW 2319 EPSTEIN - D1rect/Ho 111ngshead 100 1 data on personal monitoring in the bagging area of 2 VC. This will give you no indication as to levels 3 inside the body from elution of vinyl chloride from 4 PVC dust particles and agglomerates. 5 Second, it will give you no indication 6 whatsoever as to VC levels resulting from thermal 7 degradation due to pyrolysis and welding. 8 Additionally, it will give you no 9 indication whatsoever as to the gradual and sustained 10 long term degassing, continuing degassing, as Gollob 1 1 pointed out, from clothing and skin and this kind of 1 2 thing, so the bagging, the personal monitoring in the 13 bagging area will merely give you one aspect of a 14 fairly complex problem. 15 Q. But isn't the purpose of the personal 1 6 monitoring that is done by an outfit such as Gollob 1 7 intended to show what the level of a particular 18 chemical is in the atmosphere in the breathing zone 19 of the individual? 20 A. Precisely, but it won't tell you what is 2 1 occurring, what is inside the body. 2 2 Q. Well 23 A. Hang on one second. And it wouldn't tell you 24 also what would happen a few feet away where there's 25 sealing and where there's welding. RNW 2320 EPSTEIN - Direct/Ho 11ingshead 101 1 Q. In your attempting to determine what is 2 in the breathing zone of the individual in the 3 bagging room, would not the personal monitoring 4 that's done particularly over an eight hour basis 5 give you an accurate indicator of what the individual 6 has breathed in, no matter where he is in that room 7 during the course of the day? 8 A. 9 Not at all. First of all, you said eight hours, I 10 don't know that it was eight hours, it may have been 1 1 for a shorter period of time. 1 2 Q. My question was hypothetical. 1 3 A. I beg your pardon, I thought you were 1 4 asserting it was eight hours. 15 Q. I am not. If we had gone over the 16 course of eight hours, would that give an accurate 17 indication of what that person breathed in in terms 1 8 of that chemical during those eight hours? 19 A. That person, yes. But a person working a few 20 feet away the answer is no, and even as far as that 2 1 person is concerned, it would give you no indication 22 as to what levels of VC his larynx or his lungs were 23 exposed to because of the additional very rapid high 24 level exposures from elution. 25 Q. Are you talking about the fact that the RNW 2321 EPSTEIN - Direct/Hollingshead 102 1 individual may have digested or swallowed some of the 2 res ins ? 3 A. Not an individual may have, any individual in 4 the bagging area would inhale substantial amounts of 5 PVC particulates and therefore there would be 6 continuing elution of VC from the PVC in his body, in 7 his or her body. 8 Q. Now, all of this I assume is preliminary 9 to your conclusion that it's basically impossible for 1 0 you to determine at this point in time what the 1 1 exposure levels were that Mr. Peterson had during the 1 2 course of his employment at ATC; is that fair? 1 3 A. What I would say is he was exposed on a 14 continuing basis that particularly in that early 1 5 period to very high levels of PVC dust and also to 1 6 variable levels of vinyl chloride which on occasion, 17 which on substantial occasions would have been very 1 8 high from these, considering these multiple and 1 9 separate types of exposure. 20 Q. Now, over the course of the last half 2 1 hour we were talking about PVC then VCM, let's go to 22 asbestos for a moment. 23 A. Sure. 24 Q. Do you have any indication from any of 2 5 the information available to you as to what Mr. RNW 2322 EPSTEIN - Direct/Ho 11Ingshead 103 1 Peterson's level of exposure was to asbestos? 2 A. Well, again, the answer is no. And the reason 3 for this is the failure of UC to supervise work 4 practices at ATC and the failure of ATC to have 5 undertaken any monitoring. 6 Now, having said that one can say that 7 he clearly was exposed to asbestos, the evidence of 8 this is coming from two sources. 9 One, the radiological changes in his 10 lungs; and two, the description of the work 1 1 practices. 1 2 Q. What description of the work practices 1 3 are you referring to that gives you the indication 1 4 that he was exposed to asbestos? 1 5 A. Well, I'm told by information perceived from 1 6 Mr. Levinson's office that, and also the Davidson 17 depo that he repaired brake linings, but this was 18 quote "not a frequent job". 19 Q. Now, whose quote is that? 20 A. That was Davidson's quote, "Not a frequent 2 1 job" . 2 2 Q. Let me rephrase my question. 2 3 Do you have any information that comes 24 from Mr. Peterson himself as to what his history of 25 exposure to asbestos at ATC was? RNW 2323 EPSTEIN - Dlrect/Hol1Ingshead 104 1 A. Yes. 2 Q. What? 3 A. That he changed brake shoes in large carriers. 4 Q. Where do you get that information from? 5 A. From Mr. Levinson's office. 6 Q. What document or other piece of 7 information provided you with such information? 8 A. You may recall you asked me this morning, and 9 I said that in addition to the original documents, he 1 0 sent me a personal list on occupational history. He 1 1 subsequently sent me a oneor two-pagestatement 1 2 dealing with his exposures to asbestos. 13 Q. Do you recallwhen you received that? 1 4 A. I think sometime in the late summer but 1 5 certainly before I wrote my preliminary report. 1 6 Q. If I recall what you said earlier, you 17 don't have a copy of that document at this time, 18 correct? 19 A. Correct. As I've mentioned on several 20 occasions, all the information I have got I have 2 1 abstracted and summarized and this information is 2 2 contained in my files. 23 MR. HOLLINGSHEAD: Mr. Levinson, in 24 light of the fact that Dr. Epstein did not apparently 25 retain at least a sizeable amount of the information RNW 2324 EPSTEIN - Direct/Ho 11ingshead 105 1 provided by your office, I would ask you if you could 2 tell me exactly what it is that he received. 3 You may or may not be able to, but I am 4 specifically concerned with this document from your 5 office that would indicate that Mr. Peterson had 6 exposure to asbestos at the time of his employment at 7 ATC . 8 MR. LEVINSON: Sure. 9 MR. HOLLINGSHEAD: Do you recall that 10 document ? 11 MR. LEVINSON: Yes, the first document 1 2 to which reference has been made is the narrative, 1 3 the history given to me by Peterson in great detail. 14 MR. HOLLINGSHEAD: Which you supplied to 15 Dr. Epstein? 16 MR. LEVINSON: Right. In that history 17 he did tell us that the first six months he was 1 8 employed by OTD his job was maintenance mechanics, 19 and in that job he would put brake linings on these 20 large carriers and picked up these 20 ton containers 2 1 of PVC and would, in turn, dump them into the hopper 22 which went into the bagging room. That's where that 23 came from. But I will provide you with it. 24 MR. HOLLINGSHEAD: I would ask for a 2 5 copy of that because Dr. Epstein clearly has referred RNW 2325 EPSTEIN - Direct/Ho 11ingshead 106 1 to it in his report. 2 MR. LEVINSON: I have a copy of that at 3 the office, I will make a note of that. 4 MR. HOLLINGSHEAD: Thank you. 5 Q. Dr. Epstein, did you read the deposition 6 of Mr. Peterson? 7 A. With difficulty. The copy I got was 8 extraordinarily illegible. I asked Alfred if he had 9 a better copy and I did go through it. 10 Q. Based on what you could read, do you 1 1 recall his testimony at all with regard to the issue 1 2 of asbestos? 1 3 A. To be quite frank, I can't recall. 1 4 Q. Your memory is correct because I can 1 5 tell you that there is no reference in his deposition 1 6 to asbestos exposure. 17 A. The thing I say that triggered me on this was 1 8 the radiological report. 19 Q. That's the one by Dr. Velez? 20 A. No, before that. 21 22 A. Q. No. Oh, I'm sorry. In April '85, the calcified right 23 diaphram, that's atypical asbestos pathology. 24 Q. So your information on this issue, that 25 is the exposure asbestos came from the narrative RNW 2326 EPSTEIN - Direct/Hoi1ingshead 107 1 supplied by Mr. Levinson's office, as well as your 2 review of that radiological report and additionally 3 something in Dr. Davidson's deposition I think you 4 said? 5 A. Davidson, two other things Davidson talks 6 about, that is repairing the brake linings wasn't a 7 frequent job and Velez also refers to the asbestos, 8 Dr. Velez. 9 Q. Those are the areas or the sources for 10 your information on asbestos? 1 1 A. I haven't quite finished his asbestos 1 2 exposure. 1 3 Q. Go ahead. 1 4 A. There were two types of asbestos exposure; one 1 5 was the changing in the brake shoes, which wasn't a 1 6 frequent job in the first six months, but clearly was 1 7 enough to produce the radiological changes; and 1 8 secondly, there was a very, very minor additional 19 exposure, he assisted the boiler workers about once a 20 year or so in replacing the insulation of the doors 2 1 with asbestos rope and that was once a year, '63 to 2 2 ' 73 . 23 Q. Is it your opinion that the asbestos 24 exposure, as you understand it to be, could have 2 5 caused his laryngeal keratosis and subsequent RNW 2327 EPSTEIN - Direct/Ho 11ingshead 108 1 laryngeal cancer in the absence of any other chemical 2 to which he might have been exposed? 3 A. Ves. 4 Q. Is there literature support for that 5 opinion, and I would refer you now to your appendix 6 on asbestos, which is Appendix 1, and I realize you 7 put some of the articles and studies in here, so I 8 would refer you to that when I ask you this question, 9 and I will repeat it; if you could point me to the 1 0 literature support that would specifically conclude 1 1 that ? 1 2 A. It is summarized in that particular appendix, 1 3 the studies on asbestos in relation to laryngeal 1 4 cancer. 15 Q. All right. Before we get into that, 1 6 allow me to ask whether or not there are different 17 forms of asbestos, to your knowledge? 1 8 A. Yes, I don't know what form of asbestos he was 19 exposed to. 20 Q. You anticipated my next question. 2 1 A. I have no idea at all. 22 Q. All right, would it make a difference in 2 3 your opinion and in your review of the literature as 24 to which form of asbestos he was exposed to? 2 5 All asbestos is carcinogenic. RNW 2328 EPSTEIN Direct/Hollingshead 109 1 Q. Have you had any experience with 2 asbestos in litigation before this? 3 A. Yes. With due respect, I think you asked me 4 this. 5 Q. I may have. I also may have forgotten. 6 A. There was one case, laryngeal cancer which I 7 mentioned to you earlier this morning. 8 In addition to that I think I had one in 9 relation, one case. I've done very little asbestos 1 0 litigation but there was one I believe on an atypical 1 1 mesothelioma. I think I've only had one or two, 1 2 maybe three. 13 Q. Based on the information available to 1 4 you, do you have a recollection or a reaction as to 1 5 when Mr. Peterson was last exposed to asbestos in his 1 6 employment at ATC? 1 7 A. I would say the last substantial or the last 18 significant exposure would have been in '67 to '68. 19 Q. And is that because at that point he 20 changed that particular job? 2 1 A. No, because according to the information that 22 I got, the changing of the brake shoes, which was not 23 a frequent job, was in the first six months '67 to 24 ' 68 . 25 Q. Is there a latency period for laryngeal RNW 2329 EPSTEIN - Direct/Hoi1ingshead 110 1 cancer, an average latency period from exposure to 2 the carcinogenic agent until the actual manifestation 3 o f the cancer ? 4 A. Well, it's really impossible to answer that 5 because latency will depend on the intensity of the 6 exposure, the duration of the exposure, the age of 7 the first exposure on a very, very wide range of 8 cancers, very wide range of factors and also 9 particularly individual carcinogens tend to have 1 0 different patterns, so it's really not possible to 1 1 answer that. 1 2 The only real way one can -- the only 1 3 kind of relevant information in this is in relation 14 to data on cessation of exposure, analysis of risk 1 5 factors in relation to cessation of exposure, and we 1 6 have reasonable data on that when it comes to smoking 1 7 because that is an example of a carcinogenic exposure 18 which at relatively early stages for respiratory 19 tract cancers can be reversible, so when it comes to 20 smoking, one can discuss this in relation to 21 specifics of latency. 2 2 It's really not directly relevant but 2 3 it's as close as I can come to answering your 2 4 quest ion. 2 5 Q. You mention in your Appendix 1, is it RNW 2330 EPSTEIN - Direct/Ho 11Ingshead 111 1 Vigliani et al? 2 A. Yes. 3 Q. Studies in 1965 with regard to asbestos 4 workers with respiratory tract cancers? 5 A. Yes. 6 Q. Do I understand you correctly that of 7 the 19 asbestos workers one of them had laryngeal 8 cancer, but all of them had general respiratory tract 9 cancers, and I'm referring you to the top of Appendix 10 1 . 1 1 A. They had different kinds of respiratory tract 1 2 cancer. 1 3 Q . A11 of them? 1 4 A. Yes. To the best of my recollection some of 1 5 them were bronchial carcinomas and others were 1 6 mesotheliomas, but I can't recall the relative 1 7 distribution of these. 1 8 One of these additionally, besides his 1 9 respiratory tract cancer, also had a laryngeal 20 cancer, too. 2 1 Q. If you know, what is the general rate of 2 2 laryngeal cancer in the population at large? 23 A. In males it's about 8.5 per 100,000. 24 Q. Would that be considered a rare cancer 2 5 or a frequent cancer or something in the midst? RNW 2331 EPSTEIN - Direct/Ho 11ingshead 1 A. I consider that an uncommon cancer, but 112 2 incidentally, this figure of eight and a half per 3 100,000, you're bringing up a very interesting point 4 because the age distribution, because that's an 5 overall in the total population. Of course the -- 6 laryngeal cancer is relatively uncommon under the age 7 of 60 . 8 Q. So the 8.5 out of 100,000 would take 9 into account both those persons under 60 as well as 10 over ? 1 1 A. It's an overall figure. 1 2 Q. So the suggestion is at above the age of 1 3 60 it is not quite uncommon? 1 4 A. It's not a suggestion, it's a fact. It's an 15 uncommon cancer, laryngeal cancer, but it's much more 1 6 common after the age of 60 than under the age of 60. 1 7 Q. Is there any significance to be drawn 1 8 from the fact that one out of 19 asbestos workers 19 with respiratory tract cancers have laryngeal 20 cancer? Put differently, is that consistent with the 2 1 general population or is that considerably higher 2 2 than the general population figure? 23 A. It could have been a fluke, it's difficult to 24 answer that. On the other hand, it's a pointer, 25 that's the reason why I mentioned it there because it RNW 2332 EPSTEIN - Direct/Hollingshead 1 was an interesting pointer of literature that 113 2 subsequently was confirmatory, had I just seen that 3 by itself and had that been all the information there 4 was, one may not necessarily have ascribed a high 5 degree of relevance to that. 6 Q. Was the Vigliani study what is known as 7 an epidemiological study? 8 A. Well, it's an epidemiology study in the sense 9 there were a series of case reports. 1 0 In other words, it was an analysis of 1 1 asbestos workers with respiratory tract cancer and 1 2 among them there was one case of laryngeal cancer. 1 3 Q. Does the author draw a conclusion at all 1 4 with regards to the relationship between asbestos and 1 5 laryngeal cancer in that report? 1 6 A. To be quite frank, I've forgotten. 17 Q. Do you have it as part of your notebook? 1 8 A. If I have it here I will show you. I don't 19 think I have. 20 No, I haven't. 2 1 Q. Is there any indication in the report to 2 2 your recollection as to the frequency deration or 2 3 extent of exposure to asbestos of these workers? 24 A. I don't recall. 25 Q. With regard to the Stell & McGill study RNW 2333 EPSTEIN - Direct/Ho 11ingshead 114 1 which is referred to in Appendix 1, what do you 2 recall about that particular study? 3 A. This was an analysis of cases of laryngeal 4 cancer. It was a fairly brief report and it was 5 noted that of the cases of laryngeal cancer, in about 6 17 of them there was a history of asbestos exposure. 7 Q. Specifically there were 59 cases of 8 laryngeal cancer that were studied by the authors? 9 A. Correct, and this was statistically signified. 10 Q. Was this also a series of case reports? 11 A. Actually this was just an analysis of 59 cases 1 2 of laryngeal cancer and in each of these they looked 13 into occupational history and just reported this. It 1 4 wasn't a formal epidemiological on a cases total 1 5 study, but it was just a brief report, almost like a 16 preliminary report. 17 Q. To your recollection, did the authors 18 draw any conclusion as to a connection between 19 asbestos and laryngeal cancer with the study? 20 A. I'm pretty sure they did. I may have it here. 2 1 Yes, I do have it here. 2 2 Q. Are you referring now to the back of 2 3 your notebook? 24 A. Yes, the Stell & McGill study. It was 2 5 exposure to asbestos is most likely to be of RNW 2334 EPSTEIN - Direct/Ho 111ngshead 115 1 importance in laryngeal cancer in a more deep study, 2 and a more detailed study of this group is being 3 under-taken . 4 Q. Does that result of the Stell & McGill b 5 study that is reported in your appendix? 6 A. Correct . 7 Q. I take it they followed up at a 8 subsequent point and came up with another study, 9 that's what that study indicates? 10 A. That was the 1973 b study and what they found 1 1 there, a highly significant association between 1 2 occupational exposure and to asbestos and laryngeal 1 3 cancer. There was one problem about this study, they 1 4 noted that there were more smokers among the patients 1 5 with laryngeal cancer than in the controls, so that 1 6 makes this study somewhat difficult to interpret 1 7 because if you're smoking there's an additional 1 8 factor, but nevertheless the study was in general 1 9 consistent. I would regard it as consistent with 20 other studies in demonstrating cause and associations 2 1 between laryngeal cancer and asbestos exposure. 2 2 Q. Can you tell from the article or copy of 2 3 the study in your notebook as to what the frequency 24 duration or extent of exposure was, or is it not 2 5 noted? RNW 2335 EPSTEIN - Direct/Hollingshead 116 1 A. I'm pretty sure it was not noted. 2 Q. Was it your understanding that these 3 were workers? By that I mean the people who studied 4 in the Stell & McGill studies, these were workers in 5 the asbestos industry? 6 A. Yes. 7 Q. In the manufacturing end of the asbestos 8 industry, do you know? 9 A. I can 1t recall. 10 Q. Does the study indicate what exactly the 1 1 higher percentage of non-smokers was among the 1 2 controls or put in the reverse, what the percentage 1 3 of smokers within the group of workers with laryngeal 1 4 cancer was? 1 5 A. I can't recall, I'm sorry. 1 6 Q. Did the study itself indicate that? 1 7 A. It may give data, I can't recall whether it 1 8 does, but the study criticized itself or rather 1 9 recognized the limitations while stating that the 20 results showed cause and association, appear to show 2 1 cause and association, it recognized that as a 2 2 limitation, the fact that there were more non-smokers 2 3 in the controls than there were in the test group. 24 Q. My question, if it wasn't clear though, 2 5 was just asking whether or not there is a number RNW 2336 EPSTEIN - Direct/Ho 11ingshead 117 given for the greater percentage of smokers? A. I'm sorry, I don't recall. Q. Well, the study is right here, does it 4 have it? 5 A. I don't have that here. 6 Q. You're referring to the b study which 7 you don't have a copy of? 8 A. Well, I have -- all that I have for the b 9 study is just a very, very brief summary. For 10 instance, I say the patients' smoking habits were 1 1 similar with respect to the exposure to asbestos, but 12 I don't have the exact figures. In fact, I don't 1 3 have any figures at all for that. 14 Q. Does the study, in any way, in your view 1 5 support the proposition that laryngeal cancer can 1 6 also be related to smoking cigarettes? 1 7 A. There's no question. 1 8 Q. That can be related? 19 A. Of course, there's a clear literature on 20 smoking and laryngeal cancer. 2 1 Q. Can you cite that literature anywhere in 2 2 your preliminary report? 23 A. I recognize this, sure, I'm certain I do. In 24 the preliminary report look at page two. Excuse me, 2 5 do you have page two of the preliminary report? RNW 2337 EPSTEIN - Direct/Ho 11ingshead 118 1 2 A. Q. Yes . Under item number six? - 3 Q Yes , but there's no studies listed 4 there. The U . S . Surgeon General report ? 5 A. That's right. You'll find in the section of 6 larynx cancer several studies on the relationship 7 between smoking and laryngeal cancer. 8 Q. While we're on the subject, why don't we 9 turn to that and you can point out the studies for 10 me . 1 1 A. Well, I will lead you. 1 2 Q. I'm sorry, you're referring to the 13 preliminary report? 1 4 A. Sure. 1 5 Q. Let's turn to the preliminary report and 1 6 if you would go to any section in here that talks 17 about smoking which cites particular studies? 18 A. Any section in where? 19 Q. In the preliminary report. 20 A. There isn't, just a statement that they're 2 1 recognized risk factors. 2 2 Q. What page are you on? 23 A. Page two, "While alcohol and smoking, 24 particularly in combination and at high exposure 25 levels are recognized risk factors" -- in other RNW 2338 EPSTEIN - D1rect/Ho 11ingshead 119 1 words, this is well recognized in the literature. 2 Q. Can you give me an indication in the 3 literature where I can find that if I wish to go read 4 that ? 5 A. Sure, you will find, first of all, at the 6 beginning of the section marked "Larynx Cancer", 7 there's a heading marked "Lifestyle". 8 Q. You're now referring to the notebook, 9 not the preliminary report? 10 A. That's correct. And then it says tobacco and 1 1 alcohol, it gives a few references and then as you go 1 2 along through this, you will find about half a dozen 1 3 papers on larynx and smoking. 1 4 Q. So there are references within your 1 5 notebook that I can look at? 16 A. Sure. 1 7 Q. Can you tell me, I think it's apical? 1 8 A. It means apex. 19 Q. Pulmonary fibrosis is? 20 A. It means at the apex of the lungs. 2 1 Q. You've indicated on Appendix 1 under the 2 2 asbestos section, at the end of first paragraph that, 2 3 "It should be further noted that apical pulmonary 24 fibrosis, considered to be unrelated to the asbestos 2 5 exposure, was noted in 5/31 laryngeal cancers; RNW 2339 EPSTEIN - Direct/Ho 11ingshead 120 1 pulmonary asbestosis was noted In conjunction with 2 one of these cancers." 3 Can you tell me what the significance of 4 that statement is in the context of the Peterson 5 case ? 6 A. I don't really think there is any necessary 7 association. It just happened they found in five of 8 the laryngeal cancers there was apical pulmonary 9 fibrosis and it was considered to have nothing to do 10 with the asbestos exposure. 1 1 The only reason why I mention it, it was 1 2 just an association idea of concepts because Peterson 1 3 prior to his coming to work at ATC was noted to have 1 4 minimal apical pulmonary fibrosis, but the authors of 1 5 this, the Stell & McGill people say they thought it 16 had absolutely nothing to do with it, with his 1 7 laryngeal cancer; however, one of the laryngeal 18 cancers, one of these have pulmonary asbestosis. 19 Q. Does Mr. Peterson show that he has 20 pulmonary asbestosis? 2 1 A. Yes. 2 2 Q. Do you distinguish between pulmonary 23 asbestosis and chronic obstructive lung disease? 24 A. Well, pulmonary asbestosis is generally more 25 restrictive but you can have obstructive lung disease RNW 2340 EPSTEIN - D1rect/Ho 11ingshead 121 1 in it. 2 Q. When you talk about chronic obstructive 3 lung disease In your preliminary report? 4 A. Yes. 5 Q. Which you do specifically in paragraph 6 one on page one. 7 A. Yes. 8 Q. Do you intend to mean that that is 9 different from pulmonary asbestosis which you use as 10 a different term in different locations in the 1 1 report ? 1 2 A. Well, withpulmonaryasbestosis you don't 13 necessarily have chronic lung disease. 14 Q. You mean you don't necessarily have them 1 5 at the same t ime ? 16 A. Yes . 17 is A . Q. Yes . One does not necessitate the other? The Velez report makes it very clear 19 that he had chronic obstructive pulmonary disease. 20 Q. Perhaps you just threw me again. If he 2 1 has chronic obstructive lung disease, would that be a 22 separate illness from either chronic obstructive 23 pulmonary disease or pulmonary asbestosis? 24 A. I must apologize, chronic obstructive lung 25 disease is the same as chronic pulmonary disease. RNW 2341 EPSTEIN - Direct/Ho 11ingshead 122 1 Pulmonary asbestosis is from the point 2 of view of lung function tests, which Dr. Velez is 3 the expert and I'm not, is more of a restrictive lung 4 disease. 5 So he had, in fact, two types of lung 6 problems; one, the chronic obstructive lung pulmonary 7 disease or lung disease and also restrictive disease 8 characteristic of pulmonary asbestosis. 9 Q. Is it your opinion chronic obstructive 1 0 lung disease can be caused by exposure to asbestos 1 1 without regard to any other chemical exposures? 12 A. Well, it's more in terms of the restrictive, 1 3 but you can't have chronic obstructive lung 14 disease -- 1 5 Q. Would you necessarily have chronic 1 6 obstructive lung disease as a precursor to pulmonary 1 7 asbestosis? 18 A . No . 19 Q. You can't have pulmonary asbestosis 20 without having chronic obstructive lung disease? 2 1 A. That's my understanding, but I would refer to 22 Dr. Velez. 23 Q. But it would be your understanding and 24 your opinion that pulmonary asbestosis is caused by 2 5 asbestos exposure? RNW 2342 EPSTEIN - Direct/Ho 11ingshead 1 A. By definition. 123 2 3 A. Q. Yes. One would think? 4 Q. That we can agree on? 5 A. I thought we've agreed on virtually 6 everything. 7 Q . Probably. 8 Going back to a question or series of 9 questions I posed to you just a little while ago 1 0 about the cigarette smoking, looking at your Appendix 1 1 1, I note and I want to correct the record if that's 1 2 necessary, that you do have a reference to cigarette 13 smoking being associated with laryngeal cancer, it's 1 4 the Shettigara and Morgan report of 1975, am I 15 reading that correctly? 1 6 A. Sure, but that was part and parcel, that 17 really wasn't a study on cigarette smoking per se, it 1 8 was a study on asbestos exposure in which smoking was 19 considered, so this isn't a definitive reference on 20 smoking. 2 1 Q. There there was no reference in the 2 2 preliminary report? 2 3 A. Yes, there was no reference to study of 24 smoking, this was purely experimental on the study of 25 asbestos. RNW 2343 EPSTEIN - Direct/Ho 111ngshead 124 1 Q. Is It your opinion that to a reasonable 2 degree of medical probability that Mr. Peterson's 3 exposure to asbestos during his employment at OTD and 4 ATC has placed him at excess risk of future disease 5 and cancers? 6 A. It's one of the factors, sure. 7 Q. When you say with regard to the 8 relationship between asbestos and an increased risk 9 or excess risk of future disease and cancers, are 1 0 there any particular future diseases that you have in 1 1 mind or particular future cancers that you have in 1 2 mind? 1 3 A. With relation to what, asbestos? 1 4 Q. Yes. 1 5 A. Yes, bearing in mind that I say asbestos is 1 6 only one and not necessarily the most important one, 17 but restricting your response just to asbestos, the 18 cancers which one would have to consider would be the 19 following: Would be bronchial cancer or lung cancer, 20 firstly; secondly, would be mesothelioma; and 2 1 thirdly, would be gastrointestinal cancer, 2 2 particularly a colorectal cancer, there are some 2 3 other rarer cancers associated with asbestos, but 24 those are the ones which I would have particular 2 5 concern for only with relation to the asbestos. RNW 2344 EPSTEIN - Direct/Hollingshead 1 Q. Now, the listing you just gave me, 2 they're all cancers, if I heard you correctly? 12 5 3 A. Correct. 4 Q. Are there any other diseases other than 5 cancer that he has in excess risk of contracting? 6 A. From specifically the asbestos exposure? 7 Q. Yes. 8 A. Sure. From any -- when you have pulmonary 9 fibrosis and asbestosis, you can have, first of all, 10 an increased susceptibility to infection and 1 1 therefore pneumonia, and also you can have 1 2 cardiovascular strains which can result in addition, 13 that's called cor, C-o-r, pulmonale 14 P-u-1-m-o-n-a-1-e, which is an essentially right 15 heart failure, as the lung, as you have fibrosis and 1 6 scarring in the lung it becomes more difficult to 17 pump blood through the lungs from the pulmonary 18 artery, so the right heart can gradually enlarge and 1 9 you can get right heart failure? 20 MR. HOLLINGSHEAD: I have to take a very 2 1 short break. 2 2 (Recess is taken.) 23 Q. With regard to the cancers that you 24 indicated, the mesothelioma is a cancer that is 25 linked specifically with asbestos, is it not? RNW 2345 EPSTEIN - D1rect/Ho 11ingshead 126 1 A. Well, actually there's two kinds of 2 mesothelioma, there's a plueral of mesothelioma, 3 that's a lining of the lung and peritoneal lining of 4 the abdomen, both of them to all intents and purposes 5 are exclusively related to asbestos exposure. 6 Q. So regardless of any other exposure that 7 Mr. Peterson had, the future risk for these cancers 8 could only be associated with asbestos exposure, am I 9 correct? 10 A. With relation to these mesotheliomas? 1 1 Q. Yes, the mesotheliomas could only be 1 2 related to asbestos exposure? 13 A. Right. 1 4 Q. I may have read your report incorrectly 1 5 in this regard, but I thought you also suggested that 16 the colon or rectal cancers would also primarily be a 1 7 result or a possible result of under the exposure to 1 8 asbestos? 19 A. I didn't say that at all. What I said was 20 they are risk factors to colorectal cancer. 2 1 Q. Well, you've indicated on page one of 2 2 your report at the bottom, and I'm not quoting the 23 entire section, but you say that there is a risk of 24 pulmonary mesothelioma and colon cancer from 2 5 asbestos? RNW 2346 EPSTEIN - Direct/Ho 111ngshead 1 A. Correct . 127 2 Q. Now, that is from there that I had the 3 impression that you were saying the potential future 4 risk of colon cancer was a result of only asbestos 5 exposure, have I misread it? 6 A. Not an unreasonable interpretation, but it's 7 not actually correct because I go on to say, also 8 cancers at a wide range of other sites, and the 9 reason for that being is because the VC/PVC, 10 viny1ch1oride produces a very, very wide range of 1 1 which gastrointestinal tract happens to be one, I 1 2 don't specify all of them, though, I just say a very 1 3 wide range of sites. 14 Q. Do you have an opinion as to the 15 particular likelihood that Mr. Peterson will contract 1 6 a mesothelioma in the future from asbestos exposure? 17 A. I would defer to Dr. Velez on this, he's much 1 8 more experienced in the asbestos area than I am. 19 I believe it's generally a five-fold 20 risk, something of that kind, but this isn't my area 2 1 I wouldn't profess to on a high level of expertise. 22 Q. I understand that and I accept it. I 2 3 want to ask you what you mean by five fold? 24 A. In other words, his risk of lung cancer is 2 5 increased five fold that of the general population. RNW 2347 EPSTEIN - Direct/Ho 11ingshead 128 1 Q. Five fold, do you mean five times as 2 great ? 3 A. Yes, five times greater than that, again, I 4 defer to Dr. Velez on this. 5 Q. Just speaking of this issue in general, 6 what is the general risk that any of us run that we 7 will contract cancer in our lifetime? 8 A. Basically on an overall basis one in three 9 chances, and of contracting and diagnosis, one in 1 0 four. 1 1 Q. If I understand you correctly, it's one 1 2 out of three in terms of the risk of contracting 1 3 cancer and one out of four of contracting and 1 4 diagno sing ? 1 5 A. Correct . 1 6 Q. Now, that would be with regard to all 17 varieties of cancer? 1 8 A. That's the total U.S. population, that's an 19 overall figure for cancer incidents, excluding skin 20 cancer of incidents and mortality. 2 1 Q. Why does it exclude skin cancer? 22 A. Just the quirk of the way it's reported, 2 3 because there's a pretty wide range of skin cancers, 24 the reporting for skin cancer is much less good. 25 In other words, somebody could have a RNW 2348 EPSTEIN - D1rect/Ho 111ngshead 129 1 little bit of nodule on the skin which can be excised 2 and not be reported. Generally, when you talk about 3 overall incidents and overall mortality, you 4 generally relate this to cancers and you say it's 5 almost like a religious caveat. When it comes to 6 mortality, of course, that would be a different 7 matter, but when it comes to incidents, one would be 8 screwing up the data by including skin cancer. 9 Q. Is it generally considered by doctors 1 0 that skin cancer is more prevalent than other forms 1 1 of cancer, as well? 1 2 A. It depends exactly where you are, because in 1 3 the south you can have, particularly where there's a 1 4 lot of sun, premalignant changes, keratosis of the 1 5 skin, skin cancer is much more common, so as I say 1 6 the overall figure is one in three and one in four, 17 I'm excluding skin. 18 Q. Now, when you said a moment ago, 19 recognizing that you defer to Dr. Velez, the 20 pulmonary and asbestos expert in the case, when you 2 1 said a moment ago that you would anticipate that Mr. 2 2 Peterson's excess risk of contracting mesothelioma is 2 3 perhaps five fold, are you talking five fold that 24 normal risk of anyone contracting cancer? 25 A. No, excuse me -- RNW 2349 EPSTEIN - D1rect/Ho 11ingshead 130 1 Q. One In three? 2 A. I may have misspoken. I think what really I 3 should have said would be his risks of contracting 4 malignant disease of the lung, somebody with 5 asbestosis has about a five fold increase the risk of 6 getting a lung malignancy which includes a bronchial 7 carcinoma and mesothelioma. 8 Q. Well, I'm not sure you misspoke, because 9 my question was specifically geared to mesothelioma, 1 0 I did not open it up to -- 1 1 A. I beg your pardon, essentially what I was 1 2 talking about, what I should have been talking about 1 3 was malignant lung disease. In other words, if you 1 4 have asbestosis your chances of getting malignant 1 5 lung disease is somewhere, what, in the region of 1 6 five fold. 17 The reason one has to put it this way is 1 8 because the general population has no reason at all 19 in getting mesothelioma, so it would be a meaningless 20 statement when it comes to mesothelioma. What I was 2 1 talking about was malignant lung disease, I'm sorry. 22 I really expressed very clumsily. 23 Q. Well, if we used that understanding that 24 you're talking about malignant lung disease, when you 25 say that someone might have a five-fold risk factor. RNW 2350 EPSTEIN - Direct/Ho 111ngshead 131 1 are you saying that that is a risk factor above the 2 standard one in three risk factor that the general 3 population has? 4 A. No, the one in three is an overall for all 5 cancers. 6 Q. Yes, I'm just trying to understand what 7 you're saying. 8 A. Sure. If you look at the general population, 9 what are the chances of the general population 10 getting lung cancer, and then the chances if you have 1 1 asbestosis, it is a five-fold risk. But again, as I 1 2 emphasize, I defer -- what I'm saying is, if you have 1 3 asbestosis there is a substantial increased risk of 1 4 getting malignant disease of the lung. More than 15 that I would wish to defer the specifics to Dr. 1 6 Velez. 17 Q. I won't press too hard, but of the two 1 8 people involved in this deposition testimony, you 19 have a little more information than I do, so let me 20 probe one second longer. 2 1 Do you have a percentage figure in mind 2 2 for the risk that anyone runs of contracting lung 2 3 cancer in his or her lifetime? 24 A. Well, it depends whether they're smokers, of 2 5 course, and you have to break it down to smokers or a RNW 2351 EPSTEIN - Direct/Ho 11ingshead 132 1 smoker can have a ten percent, It's very difficult to 2 say this because all you can relate is that the 3 amount of smoking and deration of smoking, but say 4 you have all of these factors, you can say roughly 5 how many people get lung cancer every year, let's say 6 it's 100,000 lung cancer deaths and 400,000 or say 7 450,000 overall deaths, so one can say a little more 8 than a quarter of all cancer deaths are due to 9 smoking -- more than a quarter of all cancer deaths 10 are due to lung cancer. 1 1 Q. Is this another area that you would feel 1 2 more comfortable deferring to Dr. Velez? 1 3 A. Which area? 14 Q. The discussion of increased risk on lung 15 cancer ? 16 A. In smoking? 17 Q. In smoking or -- 1 8 A. No, I'm fine as far as smoking is concerned, 19 it's in relation to the asbestos that I would defer 20 to him. 2 1 Q. Let's go to the appendix on vinyl 2 2 chloride and PVC which I believe is 2. 23 A. Yes. 24 Q. Do you have the Harris report with you 25 in your notebook? RNW 2352 EPSTEIN - D irect/Ho 11ingshead 133 1 A. Which was that? 2 Q. Harris, 1953, referring to VC levels 3 ranging up to 8,000 ppm? 4 A. No . 5 Q. Do you have a recollection as to which 6 particular form of PVC Harris was referring to? 7 A. I don't recall. My guess is it must have been 8 suspension. 9 Q. Why is that ? 1 0 A. Because that's the highest. In general those 1 1 are the highest levels. I mean that's the resin for 1 2 the highest levels. 13 Q. Do you know how much residual vinyl 1 4 chloride is contained in the various manufacturing 1 5 methods that were used in the resin that was shipped 1 6 to ATC? 1 7 A. How much? 1 8 Q. At the time of manufacture? 19 A. I thought we discussed this. According to 20 Wheeler it's 860 ppm. 2 1 Q. For which? 2 2 A. For the suspension. Although, I've indicated 2 3 that according to the literature much higher levels 24 of VC are recorded than of course in the bulk and in 25 the solutions there are lower levels. RNW 2353 EPSTEIN - Direct/Ho 11ingshead 134 1 Q. Do you have a number in mind to the 2 bulk? 3 A. Yes, about five to 15. 4 Q. Five to 15? 5 A. 6 7 A. Five to 15 ppm. Q. And for the solution? About `one ppm. 8 Q. That's at the time of manufacture, 9 correct ? 10 A. Correct, although not necessarily being the 11 case from '67 to '73. 1 2 Q. I'm sorry, why is that again? 1 3 A. Because I have no data on these as produced at 1 4 individual years. 1 5 Q. Doesn't Dr. Wheeler give both prior and 1 6 post '74? 17 A. Yes, but I don't recall whether he gives them 1 8 for each of these years independently. 19 The other one point I should mention is 20 that there's an inconsistency in Wheeler's statement. 2 1 He states that the levels were 860 ppm in the Wheeler 2 2 versus Maliko, but he changes his mind when it comes 2 3 to the interrogatories where it says they go up to 24 2,000 ppm. 25 Q. This is for the suspension? RNW 2354 EPSTEIN - D1 rect/Ho 111ngshead 1 A. So you pay your money and you take your 2 choice. 135 3 Yes, suspension. 4 Q. For each of the three systems of 5 manufacturing, that is the solution process, the bulk 6 process and suspension process? 7 A. Not in the solution. 8 Q. I said solution, bulk. 9 A. I beg your pardon. 10 Q. For each of those three processes, are 1 1 you aware as to whether or not after manufacture, the 12 residual vinyl chloride monomer, what's the word I 13 want, dissipates in some fashion from the resin? 14 A. Sure. 1 5 Q. Do you know the rate at which it 16 dissipates for each of the resins? 1 7 A. Well, you recall you had an extensive 1 8 discussion with Dr. Davidson. 19 Q. I do entirely but this is your 20 deposition. 2 1 A. I thought it might be helpful to refresh your 2 2 memory. 2 3 Q. My memory is quite refreshed. 24 A. Okay, it's fairly rapid degassing. 2 5 Q. For all three? RNW 2355 EPSTEIN - D1 rect/Ho 111ngshead 136 1 A. Well, for everything it's fairly rapid, it 2 depends on a wide range of considerations. It 3 depends on the initial concentration. It depends on 4 the initial concentration, blastosizes (phonetic), 5 the size of the resin particle, and a whole series of 6 factors of this kind. But in general, one can say 7 there's a non-linear degassing, in other words, at 8 high, particularly at high concentrations, degassing 9 is very rapid initially then tapers off. And 10 Wheeler, for instance, said that there was 860 1 1 initially at manufacture, by the time it reaches the 1 2 plant, reached ATC, it was somewhere down to 580 or 1 3 whatever it was, something like that. 1 4 Q. In rendering your preliminary report, 1 5 did you have any particular number in mind for any of 1 6 the three varieties of PVC resin for the amount of 17 residual vinyl chloride monomer that was in existence 1 8 at the time that Mr. Peterson was exposed to the 19 resin? 20 A. Well, I just knew that there were high levels 2 1 of residual PVC in suspension. 22 Q. You said PVC? 23 A. VC in the suspension resin and much lower in 2 4 the others. Then, of course, when it comes to his VC 25 exposures, I indicated to you thisis a reflection RNW 2356 EPSTEIN - D1rect/Ho 11Ingshead 137 1 not only of the VC levels in the air but also VC 2 levels from inhaled or ingested PVC, plus other 3 sources like thermal degradation over and over and 4 above that, as I indicated before the PVC itself 5 considered to be greater importance than the VC. 6 Q. Well, let me break the three systems, 7 the three processes down for purposes of the 8 que s tion. 9 With regard to the solution process, PVC 10 which you indicated a few moments ago had a RVCM 1 1 content of approximately one ppm at the time of 1 2 manufacture ? 1 3 A. According to Dr. Wheeler, yes. 14 Q. I assume you're accepting that 1 5 testimony, are you not? 1 6 A. I really have no way of knowing whether this 1 7 was the case for all the years, but let us assume 1 8 that for a moment. 19 Q. Do you have any information from anyone, 20 Dr. Davidson or anyone else, that would suggest that 2 1 that number one ppm as RVCM number is wrong? 2 2 A. He may well be correct, but I have to have a 2 3 certain degree of caution because as I've indicated 24 to you before, Dr. Wheeler has seemed to have changed 2 5 his mind over a ten-year period as to what the levels RNW 2357 EPSTEIN - D1rect/Ho 11ingshead 138 1 of VC were in the suspension PVC, and furthermore, 2 there are other references on high levels, much 3 higher levels of residual VC and PVC than Dr. Wheeler 4 has suggested at any stage, so I really just have to 5 keep an open mind on this. 6 Q. Have you not done any independent review 7 of literature on PVC manufacturer in the preparation 8 of the report in this case? 9 A. No . 10 Q. Did you do such an independent review of 1 1 literature prior to the rendering of your report in 1 2 the Malika case ten years ago? 1 3 A. No, I just refer to the fact in the 14 literature, there are reports of much higher levels 1 5 of residual VC than Dr. Wheeler has stated. 1 6 Q. In the solution? 1 7 A. Excuse me, but what I was going to say, I 1 8 leave the details of this, I rely on the details of 19 this on Dr. Davidson. 20 Q. Well, before I leave the area, is it 2 1 your testimony that you are aware that in the general 2 2 literature that higher numbers than one ppm are 2 3 listed for the RVCM contents of the solution process 24 resin? 2 5 A. No, my discussion in relation to high levels RNW 2358 EPSTEIN - D1rect/Ho 111ngshead 1 related to suspension. 139 2 Q. Good, that's where we started. Let's go 3 back to solution process resin, you're accepting Dr. 4 Wheeler's analysis that there is 1 ppm RVCM in the 5 solution process for the purpose of rendering your 6 report in this case, are you not? 7 A. No, I'm not. I have a degree of caution in 8 accepting that in view of the disparity of the 9 levels, in the different levels he has reported for 1 0 suspension on two occasions, and it's fact that the 1 1 literature has reported much higher levels for 1 2 suspension. Now, because of these disparities I have 1 3 to have an open mind on solution, but I have not 14 investigated the matter and it's not my particular 1 5 area of expertise and I really can't go any further 1 6 than that. 1 7 Q. In particular, you don't have any 1 8 information as you sit here today that would 19 specifically tell you that Dr. Wheeler's conclusion 20 with regard to the RVCM content in the solution resin 2 1 is wrong, do you? 2 2 A. But I have information in relation to other 23 resins, therefore I have to approach all of his 24 statements on VC residual levels with caution. 2 5 Q. But you do not have any other RNW 2359 EPSTEIN - Dlrect/Hollingshead 1 information with regard to this solution? 140 2 A. Correct. 3 Q. Assume that the RVCM content of the 4 solution process resin at the time of the manufacture 5 is 1 ppm, have you utilized any particular assumption 6 as to what the RVCM level for solution resin was at 7 the time Mr. Peterson was exposed to it? 8 A. I would say it would be pretty similar. 9 Q. Around one? 10 A. 11 Around about. Q. Is there a particular reason for that? 1 2 Does that follow the explanation you gave earlier 13 that tends to leave the resin in a linear fashion and 14 then after a period of time it takes longer for that 1 5 last element to leave? 1 6 A. Correct, it's an expression, non-linear 1 7 degassing. Yes, you're absolutely right. 1 8 Q. Would that also account for why the 19 suspension RVCM level, whatever it may be, would 20 decrease rather rapidly in the beginning after 2 1 manufacture and then not continue to decrease at that 2 2 same rate later on? 23 A. Right. Rapid initial degassing, then tapering 24 of f . 2 5 Q. Would the same basic principle be true RNW 2360 EPSTEIN - Direct/Ho 111ngshead 141 1 for the bulk process which has, according to Dr. 2 Wheeler has a RVCM content of between five and 15 3 ppm? 4 A. That would be closer to the solution kind 5 because the initial levels were relatively low 6 compared to suspension, but in principle, yes. 7 Q. Did you have a particular RVCM level in 8 mind when you prepared the report as to Mr. 9 Peterson's exposure to the bulk process resin? 10 A . No . 1 1 Q. What do you mean in your report about 1 2 the middle of the first paragraph under polyvinyl 13 chloride on page three, quote, "The unreacted monomer 1 4 can be eluted out of PVC by body fluids" -- this is 1 5 where you made the change, isn't it? 1 6 A. That's okay, I don't make any change in 17 relation to that. 18 Q. Well, let me stop there in the quote 19 because what I wanted to ask you was with regard to 20 the body fluids? 2 1 A. 22 Sure. Q. I assume you are talking about after the 2 3 PVC has been in some way ingested by the body? 24 A. 25 Ingested or inhaled. Q Or inhaled? RNW 2361 EPSTEIN - D1rect/Ho 111ngshead 14 2 1 A. Sure. 2 Q. And It would be then the human body's 3 fluids that is causing some of the unreacted monomer 4 to be taken out of the PVC resin? 5 A. Yes, it would dissolve it out. 6 Q. How would that happen? 7 A. The vinyl chloride would partition itself 8 between the level in the PVC particle and the level 9 in the plasma or extra cellular fluid and you would 10 have a very rapid diffusion out or what's called 11 elution and there's very substantial repeated 1 2 references to this in the literature. 13 Q. The beginning of the following paragraph 14 reads as follows: I will read for the record, "VC is 1 5 a potent carcinogen which induces a wide range of 16 malignant neoplasms in a wide range of expermental 17 animals, rats, mice and hamsters, following chronic 1 8 inhalation, oral or parenteral exposure." With regard 19 to those, the reference to malignant neoplasms and in 20 particular looking at the rest of the paragraph 2 1 there, are there any studies that have indicated in 22 animals that laryngeal cancer has been found to be 2 3 caused by exposure to VC? 2 4 A. Not that I'm aware of. 2 5 Q. Are you aware of studies that have been RNW 2362 EPSTEIN - Direct/Ho 11ingshead 143 1 done whereby animals have been exposed to PVC resin 2 or PVC dusts? 3 A. Yes, these are listed for you in one of the 4 more recent documents which I've included. 5 Q. Is there any indication in those studies 6 that there is a connection between the exposure to 7 PVC resin or dust and laryngeal cancer? 8 A. You've asked me as to whether on laryngeal 9 cancer the PVC -- the answer is no. 10 Q. Is it Keplinger study? Is that how you 1 1 pronounce it? 1 2 A. 13 Yes. *Q. Have the Keplinger and Viola studies 1 4 been fully accepted by the community, scientific 1 5 community, to your knowledge? 1 6 Are there any flaws in those studies 1 7 that would cause them not to be readily accepted by 1 8 the scientific community? 19 A. Well, there were questions, to the best of my 20 recollection, some of the MCA has challenged, I know, 2 1 the lung tumors as to being secondary to metastasis 2 2 rather than primary. 2 3 Q. Was the Keplinger work actually 2 4 completed or was that a preliminary study that was 2 5 not completed? RNW 2363 EPSTEIN - Direct/Hollingshead 1 A. That's odd. 144 2 Q. Drawing a blank? 3 A. No, it is interesting, I report Captain Joe 4 but don't give a reference to him. I'm sure it was 5 reported to the New York Academy of Sciences, you'll 6 find no reference in Keplinger. I apologize. Captain 7 Joe worked for a non-distinguished or reprehensible 8 company, IDT, that you're very well aware of, but I 9 think the report was New York Academy of Sciences. 10 Q. Were there any criticisms at Viola other 1 1 than indicated from Maltoni with regard to the 1 2 concentration level of VC that you exposed to 13 scientific animals? 1 4 A. Yes, there are a wide range of criticisms 15 against it. First of all, he gave the impression of 1 6 the report that you only got tumors at 30,000 ppm, 17 which is untrue. 18 MR. LEVINSON: Who are you discussing 19 now? 20 Q. Viola, your other expert. 2 1 A. 22 He's your boy. That was the first thing. In fact, there 2 3 were tumors down to 500 ppm, and at one of the MCA 24 meetings there was reference to the fact that he got 25 tumors down to 250 ppm, I'm pretty sure that was RNW 2364 EPSTEIN - D1rect/Ho 11ingshead 1 right for Viola. 145 2 Anyway, there were tumors down to 500 3 ppm, then my major criticism, I think that was the 4 criticism, and also the influence that these are 5 very, very rare and unusual tumors that don't really 6 have much relevance to humans, which is one point, 7 but in general Viola's paper was important an 8 statement and the first clear cut statement on the 9 carcinogenicity of compound which had been in use by 1 0 Union Carbide since 1930 which had never been tested 1 1 before for carcinogenicies, had never been tested for 1 2 over a period of four decades. 1 3 In other words, it's the first 1 4 indication of carcinogenicity or compound that had 15 been wildly used in commerce and in spite of very 1 6 substantial evidence on toxicity, in spite of also 1 7 the findings of the unreported findings of liver 1 8 cancers or angiosarcomas in workers prior to 1970. 19 Q. Well, since my question dealt with 20 whether or not there were criticism levels to the 2 1 Viola for the way he conducted the study, I will move 2 2 to strike anything after that portion of the answer. 2 3 A. Of course, another criticism was these were 24 unrealistically high concentrations and I don't think 2 5 that's a bout of criticism. RNW 2365 EPSTEIN Direct/Hollingshead 146 1 Q. Why not? 2 A. First of all, there were tumors going down to 3 500 ppm and later pointed out levels below that. 4 Q. On that paper? 5 Was there a subsequent paper by Viola? 6 A. I think it was MCA meeting, I can try and find 7 it for you. 8 Let me just go back, I have misspoken. 9 The 500 ppm that were in his data, in Viola's data, 10 there were tumors recognized at 500 ppm, also in his 1 1 paper ear tumors were noted at unspecified 1 2 concentrations below 500 ppm, they were unspecified. 1 3 Q. To your knowledge, and in your review of 1 4 the literature, when is the first time that there is 1 5 a report or study linking vinyl chloride with cancer? 1 6 A. In animaIs? 17 Q. Take whichever came first. If you wish 1 8 to take animals, I assume it's animals? 19 A. We will take what you like. The Viola data 20 with the first data in animals. 21 22 A. Q. What year was that again? 1970, some four decades after the vinyl 23 chloride was manufactured. 24 Then as far as humans are concerned, we 2 5 have the following; we have a Worker's Compensation RNW 2366 EPSTEIN - Direct/HoiIIngshead 147 1 case, Mr. Parks, I think you recall that was a B.F. 2 Goodrich case that was a Worker's Compensation case 3 in about '65, which I believe was, he had 4 angiosarcoma, and then prior to 1970 there were 5 several angiosarcomas reported. 6 In fact, from '65 to '71 there were 7 eight cases so-called liver cancer reported in VC 8 workers, and many of these were rediagnosed as 9 angiosarcoma and that was including the Parks' case, 1 0 I referred to Park or Parkers. 1 1 Then in 1969 Maltoni found malignant 1 2 type cells in the sputum of VC workers, although this 1 3 wasn't reported until 1975, and then -- I'm sorry, 14 what was your date, 1977? 1 5 Q. No, I asked you when was the first 1 6 report in the literature with regards to a link 17 between vinyl chloride and cancer, you said Viola on 1 8 the animal studies. 19 A. Viola on the animals, then a series of cases 20 and then the Maltoni findings reported in '75, 1969 2 1 findings reported in '75. 2 2 Q. At the top of page four of your appendix 23 regarding PVC and VCM, you say, and I will exclude 24 the reference to the studies, you say, quote, 25 "Numerous reports have drawn attention to the RNW 2367 EPSTEIN - D1rect/Ho 11ingshead 148 1 development of chronic pulmonary disease in VC/PVC 2 workers. The factor characterizing most of these 3 reports is chronic exposure to PVC dust." 4 A. Yes . 5 Q. Is there a reference in those studies to 6 the particular form of PVC dust that you can recall? 7 A. Not that I recall, I don't think so. 8 Q. I asked you if it refreshed your 9 recollection, didn't they all refer to the dispersion 1 0 method of manufacturing thisparticular dust? 1 1 A. I don't recall. 1 2 Q. At the end of that paragraph you say, 13 quote, "The view was expressed that the PVC dust was 1 4 likely to concentrate in and damage the small 1 5 airways, besides also acting as the carrier for 1 6 carcinogenic VC monomer." 1 7 Whose view was being expressed in that 1 8 statement? 19 A. In particular Lilis and Miller,although, in 20 fact, subsequent studies much more clear cut 2 1 statement. 22 Q. So it's intended to refer to the study 2 3 in the preceding sentence? 24 A. Yes, at this stage with that reference 2 5 subsequent more detailed statements to that effect. RNW 2368 EPSTEIN Direct/Hollingshead 149 1 Q. Towards the end of that page there's a 2 reference to the Infante studies of 1981. With 3 regard to that, my question is whether or not Infante 4 noted any laryngeal cancers in his review? 5 A. 6 No . Q. Is the follow from that therefore that 7 Infante did not conclude that the larynx was one of 8 the carcinogenicities in humans? 9 A. 10 No, not at all. Q. Why not? 1 1 A. Because it says he discussed a wide range of 1 2 sites, he said it was a multi-potent to which you can 13 get tumors in a very wide range of sites. 1 4 Q. Okay, there may be a question of 15 semantics, however, within the wide range of sites he 16 does not specifically refer to the larynx; is that 17 correct ? 18 A. No, just occur in a very wide range of the 19 sites in the body. He just happened to review the 20 data on these particular sites and emphasize those 2 1 particular sites which are much more common than 2 2 larynx. 23 Q. I'm going to ask it again for a 24 different reason. I understand what you said but I 25 asked you in a negative and you said no, which makes RNW 2369 EPSTEIN - Direct/Ho 11ingshead 150 1 it sound like a positive. 2 A. I'm sorry. 3 Q. So it is correct that he does not site 4 the larynx in particular? 5 A. As far as I recall he didn't. He discussed 6 respiratory tract cancers which could include larynx. 7 Q. With regard to the Tabershaw & Gaffey 8 study that's cited at the bottom of page 4 -- 9 A. 10 Yes. Q. -- Where there is a discussion apparently 1 1 on cancers of the larynx, pharynx and digestive 1 2 tracts, what was the incidents reported in that 13 study? In other words, how many cancers of the 14 larynx, pharynx and digestive tracts were reported 1 5 out of how many individual studies, if you know? 1 6 A. Well, you'll find it's detailed for you in the 17 table, there were about eight and a half thousand in 1 8 the initial '74 study, there were about eight and a 19 half thousand workers with at least one year 20 exposure. 2 1 One of the problems in the study was 2 2 that about 15 percent of the workers of the cohort 23 who had the highest exposure levels were missing and 24 the authors recognized, in fact, that whatever they 2 5 found would underestimate risk and then they found an RNW 2370 EPSTEIN - D1rect/Ho 11ingshead 151 1 excessive respiratory tract cancers in workers 2 particularly with over five years employment and 3 particularly with high exposures, and for respiratory 4 tract cancers there was an elevated standardized 5 mortality ratio, and among these respiratory tract 6 cancers was a one extrinsic laryngeal cancer. And in 7 addition to that the authors also recognized the 8 multiple site cancers in experimental animals, so the 9 Tabershaw & Gaffey study was of interest that they 10 recognized multiple site cancers induced in workers 1 1 and experimental animals that was in the additional 1 2 study. In the subsequent study -- 1 3 Q. Can I hold you there one second? 1 4 A. Sure. 15 Q. You say that's summarized. Just for the 1 6 record, would you say where that summary is? 1 7 A. In the more recent document entitled 1 8 Illustrative Literature On The Toxic And Carcinogenic 19 Effects Of VC/PVC In The Respiratory Tract Of Exposed 20 Workers. 2 1 Q. I think I heard you say Tabershaw & 2 2 Gaffey were looking at approximately 8500 workers? 23 A. Correct, I didn't say they were looking at 24 them in a sense, and in a sense they weren't because 2 5 1500, the data were missing on 1500. RNW 2371 EPSTEIN - Direct/Ho 111ngshead 152 1 Q. I'm sorry. 2 A. The total study was eight and a half thousand, 3 yes . 4 Q. And they were missing another 1500 of 5 the more heavily exposed? 6 A. Yes. 7 8 A. Q. Yes. But the study itself was 8500? 9 Q. Out of that, how many laryngeal cancers 10 did they have? 1 1 A. One wasnoted there. 1 2 Q. What was the subsequent studies? 13 A. The subsequent was basically an extension of 1 4 the earlier one that's in 1975, an additional 700 1 5 workers were included and again they found an excess 16 of respiratory tract cancers and here they reported 17 an additional two laryngeal cancers and pharyngeal 1 8 cancer, so we have at least three laryngeal cancers 19 among this group. 20 So in other words, of in the first 2 1 Tabershaw & Gaffey study of 12 workers with 22 respiratory tract cancers there was one extrinsic 23 laryngeal cancer, in the subsequent study of a total 24 of -- in the total cohort of 37 respiratory tract 25 cancers there were two laryngeal cancers. RNW 2372 EPSTEIN - Direct/Ho 111ngshead 153 1 Q What i s the incident s of laryngeal 2 c an c e r in the general population? 3 A. You asked me this before. 4 Q I ' m sorry. I f I did. I forget. 5 A. 08 . 5 per 100,000. 6 Q I ' m sorry, you did say that, I even made 7 a note of It. 8 A. Yes. I'm sorry, I misled you now. That's, I 9 think, for white males, or is it for white males? 10 Perhaps it's for males. Yes, I misled you a second 11 time, it's for all males. 1 2 Q. Stop misleading me and give me the right 1 3 answer. 14 A. I'm trying. It's for all males, I'm sorry. 1 5 08.5 per 100,000 for all males. 1 6 Q. In the Tabershaw & Gaffey studies, were 17 these workers in the fabricating part of the 18 industry? 19 A. Well, to the best of my recollection, these 20 were VC/PVC industries, these were PVC industries, 2 1 they were based on about nine different companies, so 22 they were VC/PVC, to the best of my recollection. 23 Q. Which would mean, in your mind, they 24 were the fabricating end of the industry or can you 25 not tell? RNW 2373 EPSTEIN - D1rect/Ho 11ingshead 154 1 A. No, I think VC and PVC, In other words, it was 2 a mix of 19 different industries. 3 Q. Is there any indication in the studies 4 as to what the exposure levels were for the various 5 workers ? 6 A. Similarly in the same way as Union Carbide and 7 ATC failed to monitor their work environment prior to 8 1974, the Tabershaw & Gaffey was based on industries 9 that similarly had failed to monitor and the exposure 10 was ranked on the basis of work practice and on 1 1 exposure deration as in terms of three levels, three 1 2 exposures, index one exposure, index two and exposure 13 index three, and exposure index three being the 14 highest exposure levels and the longest and excess 15 respiratory tract system cancers, which as you know 16 include laryngeal cancers, were found and those were 17 the highest exposure index. 18 Q. Are you aware of any study that's been 19 published that shows a connection between VC and lung 20 cancer ? 2 1 A. 22 Oh, yes. Q. Can you tell me which? 23 A. You will find a nice little table on this. 24 25 A. Q. A new section which I have not seen? Which you will be able to take home and show RNW 2374 EPSTEIN - Direct/Ho 11Ingshead 155 1 it to your experts and have some distinction in the 2 trial for me on December 15th. 3 Q. Are they summarized there. Dr. Epstein? 4 A. Beautifully. 5 6 A. Q. A simple yes would suffice. Essentially it states whether VC or PVC and 7 there's three pages for you. 8 MR. LEVINSON: You're referring to 9 what ? 1 0 Q. These all refer to the lung or 1 1 respiratory tract? 1 2 A. Respiratory tract and there's a similarkind 1 3 of table, of course, for experimental animals. 14 MR. LEVINSON: Those are all parts of 15 your record? 16 THE WITNESS: Oh, yes. 1 7 Q. Now, if I heard you correctly earlier in 18 your testimony, the larynx is considered by doctors 19 to be part of the respiratory tract? 20 A. Sure. 2 1 Q. Do any of the studies that are listed in 2 2 your beautifully prepared summary -- 23 A. Well, thank you. 24 Q. -- Indicate or show a cancer of the 25 larynx in those studies? RNW 2375 EPSTEIN - Direct/Ho 111ngshead 156 1 A. Yes. 2 Q. Can you point that out to me? 3 A. We've just been discussing Tabershaw/Cooper? 4 Q. Tabershaw/Gaffey? 5 A. 6 Yes. Q. Is that the only one? 7 A. Those are three studies, yes. I am happy to 8 say that they're basically one study reported in 9 three different ways. 10 Q. Three studies by Tabershaw/Gaffey? 1 1 A. Tabershaw and Cooper and Tabershaw and Gaffey. 12 Q. Okay. In preparing the reference 13 portion of your report on VC and PVC? 1 4 A. Yes. 1 5 Q. And perhaps better stated, what I mean 1 6 is in preparing your actual report on this subject, 17 did you have occasion to review the paper by Richard 1 8 Doll? 19 A. 20 Which one? Q. That's the one in the Scandinavian 2 1 Journal Of Work And Environmental Health in 1988? 22 A. On what subject? 2 3 Q. A review of the epidemiologic study 24 relating to health effects of vinyl chloride 25 exposure? RNW 2376 EPSTEIN - Direct/Ho 11ingshead 157 1 A. No, I'm not aware of that. Why don't you give 2 me the reference. 3 Q. I think I just did, I don't know the 4 exact -- 5 A. Doll 1988? 6 Q. Scandinavian Journal Of Work And 7 Environmental Health. 8 A. And that's on VC and -- 9 Q. It's VC and it's a review of 10 epidemiologic studies relating to the health effects 1 1 of vinyl chloride exposure. 1 2 A. Sure, I will take a look at it and chat to you 1 3 about it in December. 1 4 Q. Very good, I look forward to it. 15 MR. LEVINSON: Off the record. 16 (Discussion off the record.) 17 Q. Stay on that for a moment, if we can. 18 A. Sure. 19 Q. You indicated to me earlier that with 20 regard to your accumulation of literature on 2 1 different chemicals including PVC, it comes to your 22 attention and if it's on the subject you make a point 2 3 of it -- I'm sorry, you acknowledge it and perhaps 24 put it on the index cards? 25 A. As you've already made it clear, that's an RNW 2377 EPSTEIN - D1rect/HoI1ingshead 158 1 imperfect process as Doll has been missed. 2 Q. My question really was, is it your 3 system and. your procedure to make a note of any study 4 that comes out on the particular chemical, would you 5 only make a listing and a note of those studies that 6 you read and intend to at a later point in time rely 7 upon ? 8 A. In general I would like to try to keep abreast 9 of most of the literature on toxic chemicals, but I 10 tend to exercise my interest somewhat selectively and 1 1 I tend to keep more details, bibliographies on 1 2 certain chemicals more so than others. 13 Q. Would you say you have an extensive 1 4 catalog with regard to VC and PVC? 1 5 A. I would say it's reasonable, but obviously not 16 complete. 17 MR. HOLLINGSHEAD: Off the record. 18 (Whereupon the above deposition 19 concluded at 3:15 p.m.) 20 21 22 23 24 25 RNW 2378 EPSTEIN - Direct/Ho11ingshead 1 CERTIFICATE 2 159 3 I, CINDY L. NAGLE, a Notary Public and 4 Certified Shorthand Reporter of the State of New 5 Jersey, License No. XI01434 do hereby certify that 6 prior to the commencement of the examination DR. 7 SAMUEL EPSTEIN was duly sworn by me to testify the 8 truth, the whole truth, and nothing but the truth. 9 10 I DO FURTHER CERTIFY that the foregoing 1 1 is a true and accurate transcript of the testimony as 1 2 taken stenographically by and before me at the time, 13 place, and on the date hereinbefore set forth. 14 15 I DO FURTHER CERTIFY that I am neither a 16 relative nor employee nor attorney nor counsel of any 17 of the parties to this action, and that I am neither 18 a relative nor employee of such attorney or counsel, 19 and that I am not financially interested in the 20 action. 21 Notary Public of the Stajre of New Jersey 22 My Commission expires March 29, 1994 23 24 25 RNW 2379 EPSTEIN - Direct/Ho 11Ingshead 1 INDEX 2 WITNESS 3 SAMUEL S. EPSTEIN, M.D. BY MR. HOLLINGSHEAD 4 DIRECT 3 160 5 EXHIBITS 6 EPSTEIN EXHIBITS: 7 EXHIBIT EXHIBIT 8 NUMBER DESCRIPTION PAGE 9 Epstein 1 Notice To Take Deposition 10 Epstein 2 Report Epstein 3 Letter, dated 4/18/88 1 1 Epstein 4 Notebook 23 32 41 41 12 13 14 15 16 17 18 19 20 21 22 23 24 2 5 RNW 2380