Document a107mxZEKwMKyomYJeaXO3wXy

STANDARO FORM FOR EMPLOYER'S FIRST REPORT OF INJURY OR ILLNESS A. SM ORIGINAL to INDUSTRIAL ACCIDENT BOARD. Lymm Barnes Jjwson BM|.. Tx. '1701 if Mpt9m ft wjm `(OR ork lore than OPR 4*. 8. Jdoa iOf<nion erf incapacity to eRpRyei ifincapacity aM bevono jury aav period. an tuppuRontaf rtp*L !. Penr*v r, 300 iav be assess* for fanere to eoRdty wth the* f<srtuc:ion Sec. 7. Article 1307. Empowers liability lavi rexas empiovens' msunance AssociaTion *o++it 1671-501 THESE SPACES NOT TO BE FILLED IN BY EMPLOYER EFP..MO. a YR. inc. type CLASS!?. CODE KEY NO. COMPENSATION MEOlCAL s I* DESCRIPTION of ACC-CEnT EXPENSE I$ COVERAGE nFO. C:oy (o LATE REP. AOJ. IN. OAY OF WEEK hour of oay AGE length of EMP. OAiuy WAGE S i Name*The Dow Chemical Co, Acct. # __________ Utmm. 713 238-3702 2. miiwm m ** ^ - - ... r.ihTwTrfigpQft T exa.fi -- Zip Coot -775 41 2 3 insuredw imPtovEW miuwnc* AitoaanonHuef * . nm.i*i!>.ikntfniMiakfHinai _ Magnesium &nd Chemicals------- < l:canon of punt *9>act Mire accident occurred. * and Street 1 D'd accident Kfjt on efc'eve*s nanuses' 29 Vw C Wo- uennnenT***re oiu'W BoilST Shop injured m a %m, 3id accioeni occur on surface, underfound, att. drift or mfP . * 6. Cate of inj0v_ * 1 F*rst3v jntfit* to iav. ML. 9 then 3fl *ou o'ore*#** fust know of mpury\ .If- 6/18/75 Dr of took,, -CiIlf. Freepoff" -CoxKy.Brazoria t,.,. Texas -I t Com 775TT OepartMit rtfuUoy ewpioyM m. . A.H. 10. I Now of Day . AJ.. 8. las injured paid m full for this day1.2 PJI. Nttt of injured -- . Social >-* No.. Address No. and Si. Tewont wa ill Aft<oi Sei_ Male _ City or Ton Telethon No. Friend or Relative--. . (O Marital Status. . Statespook Efl|tr td) Minor CAittron. Vo* Zip Code Q No <ai Occupation nen injured. ft) Ves this fin or Nor feptar occupation' .ft not stilt m Mi* doparaont or bratch of *orf replvty oaptoyed) III **-- lH --pliyfl fy ymt 11 No. hours 0*1 day __5____________ (fit lofts -- - (U fioeoor tro ^^0 + time id No. dys mod per week. (ci fafrs per hour S . ,;dl Avoraft notkly lamnfi |. e' if board, lodfinj. fuel or other advantafes we lumiM m addition to nafts, |na esuaarod aarut value par day. nook or aenth . U. fas injured emoftvee officer, director, partner, orowner'. 19. Madinic. toot or th cjmsm| jery. 20. AM of poRenhand, toel. electrical, neap, ite.) 21. Part of aaoima on Much aeeidaet oeeurrid . 22 >< Name the safety appliance or refutation provided. ft) t*s it m n * tim'_ 1 23. *"BW cmm> -KMT.!.H"ww MiUr maKer -dml uxuuaed to asbestos 2 24. DtJcnst lull, IWKCKWIIoccuriuc, an)gn)*p<*-- a---- -- "qo ________________________________________ o ginno unrVing for Dow. _______________________ ; S 3 CO 29. Names and addresses of viMsias. 26. Describe the injury or illness in detail and indicate the part of My tftectad Asbestosis 27. ProMie tenfhof disaoiiify. NTL if so. date and hour________ 29. At mat occupation ___ 30. ia> Name and Mress of phyncian iff taoanu bi Name and address of kospiial nf toievni^ _ - M Has afMed returned to ors. ------ - At Milt n|t S - pr. cay Industrial Medicine_____________________ 'sx 31. Has injured diedY t. U H so, t>ve date of death One of this report 7/18/75 For records ________ f<m -- The Dow Chemical Co. Felix Ainsworth_________Tim____________ INDUSTRIAL ACCIDENT DOARO REQUIRES COMPLETION OF ALL APPLICABLE ITEMS ON THIS FORM STANDARD FORM FOR EMPLOYER'S FIRST REPORT OF INJURY OR ILLNESS A. Sad ORIGINAL ta MMCTIUL ACCtOEIT BOANO, LrMn gxnti )*n Mb. Imam, In. 7I2GI rt IMH)fa n M !roa an on iey. 8. w* lawam a imartf) to may i) acatbtity nM bason siuy a* pan, aaa aaoiaanut mot C. Pwa:r> pi SI MO aar at innal la Imam > 1y w Own iwbuIuh Sac. 1. Asticie IV. Eayraywt unlay im * Tcxa& Empusvens* ina undrice Aasocianoci V 1671-501 THESE SPACES NOT TO BE FILLED IN BY EMPLOYER State's Fur: Cm*r Eaoioyor fur drug's fft Ho,: POLICY OISTR1CT POLICY NUMBER QflU F<H l. Claim number err mo. * yr. INC. TYPE CLA&SIF. COOC KEY NO. COMPENSATION MEDICAL SS DESCRIPTION OP ACCIDENT ACCiOENT OATS EXPENSE s COVERAGE INPO. Caa.la LATE REP. AOJ. IN. DAY OP WEEK hour op oay ACE length op emp. OAILY WAGE 1 1. na iofcabio** The Dow Chemical Co,_____ Acct. # 2. on>c addrra Na. and SL. .city 't-- Freeport j. txm mwjVM' inBUHincB Aoeiarton . Cm man el towae (as afficlt amdactoiad) - Magnesium and Chemicals 713 238-3702 an Tsxas ZiCab. 77541 . Pdicy IU.. 5. i.) location ol atm a glen am accrdoM ecorab. a and Stmt -- D*b eccietw oce an aasrot' j jiaaiMi' 3 sts No. 3 0.sinntmnasa taprab Bpilsr SHOP a. o tb> it ifljurce m i turn did xcifiiM occur m surface, rtarpouM, shift, drift or Rill?__ 5 6. Data of injtrv >/\Q/7$ 19________ Day of 1 p 7. First ta uaabft to l*or. MTL 9 Vhei fi>d r or fore*ae first tw of 6/18/75 fti. Freeport ^Brazoria ta, Texas r,.r^ 77551 - - mr,mtr --1" --- Hop of Day. Ail.. . A.U. - .FJL I. Vas Mfond oa>4 <ri full for this fiay*,, . 10. Kano of fortran - PM. 11. Nanai Hijurad _ , Sxval Sacanty Na.. 12. Abbrns Na. am S.. .............................. ........ Cilya Ten___ . Sa -- ?iCebt IJ. Taltaiana la______________ Tiladmt 14a. fnand a Ntlatta_________ Spaaa tifiiia Yea Q Na 14. la) AfaIt) Sei_ Male . (c) Marital Siam. (b) Nun OliHraa. 9 ae 15. |a) Occugatian Na ajaai. Ill ml atata w did Hiaa a bnacN a ert rtfilany aaiaayab'l (I) *ai Bui In a ta lapla amain*. 1(. la) Me ln aadaub >y yea ................................. 17. II) Na in Mf bar (8) lefts ----------------- (U fiaca a tat s fens le) Na. bays Mtab fa (c) lafaa yff Ma S. .lb) A*tiefmaUy anafi t. (a) UtioW. Writ Iwiaabnabsaatafaiaanfamaiabmabbiln aniai, finiiMuMaanaaneabiy.nMaaoBNi. U. Nai laiana aamaraa aHica, diracla. pastotf, a a It. Macbaa. laal a f 22. HI a . mi -- - nan. --'NM . 21. PatdaacNnndtiaiaccmrtecanab. 20. IMbn1 Wnd,tod.ttacieal,Kan,alt.). It) Ntsdaasaatna). 2i iuetcist*camtyiwab'i'*'"*>**"f"*"beert Boiler matter .a nil"'exposed to asbestoi 24. Ofscuba tally n> accibaat acorrab. aM staff na a*day anbaMf m. miatt aaa ___________________________ cin^n wrvrVing for Dow. .. . 25. NinHMfldtitlWtf -....... ____ , ,, - CO U. Ottcti&c m mjurj or atom m ficUtl f oRieatt tho tort of body affoctofi . Asbestosis 27. Prchiftie ion|th of disafclify. NTL If so, fiCe intf hour 29. A effu^stme 30. tai N-tmoad*mofptiysiciJBftfkMm. (bi Har nj ifidfvss of hosptai <H hR0M)M br. Gay~ industrial Medicine . a. Has iriprod tofuroifi to ort'_ _ AtPAnti 1. <Sex 31. Has tf le. fivcfiatoPfiaiDi. =SPF -AO-PO- -try- Oatoof this report 7/18/75 For records fcfMbby -- -- Fun Narst-- The Dow Chemical Co. Felix Ainsworth_________wnanx_________ itoniKTBiti ihnntNT PAapn rftmart rAUPirriAM nc an sowirtoic imt am rsfte cadu Dote ALXM ft rrom STO532O06 1 /1 7 /?- DEPARTMENT OF INDUSTRIAL HEALTH AND MEDICINE MEDICAL REPORT BLOCK SO & DEPARTMENT SUPERVISOR ON DUTY TOILER SHOP J OOW TEL. EXT. MASTER A CLOCK NO ______ U2A____ t o- > OATS OF ONSET Diagnosis 6/T6/75 7/ - fo / CLASSIFICATION Q AMBULANCE REASON FOR CALL DR HISTORY las ,c:"i toiler maker and exposed to asbes tos-s i nee wordin'} for Jew, RECOMMENDATIONS TO SUPERVISOR ATTENDING PHYSICIAN ANO OR NURSE TO RETURN Cl AS NECESSARY I"! FA Asbastosis OATE INSURANCE DEFT. COPT Q INDUSTRIAL Q INSURANCE OECISION PERSONAL I C/5 cn co rs9 Paul M. Stevens, M.D. Chief, Pulmonary Section The Methodist Hospi tad 6516 Bertner Boulevard Houston, Texas 7702 TZ3CJLS MXDICAJ. CXNTZR Me. Ted Bowen President Me. Tom Fouequesar Executive Vice President June 6/ 1975 Area Coc 713-790-20' Cobi METHHOi ST0532008 W. H. Sears, M.D. 106 N. Parking Place Lake Jackson, Texas 77566 RE: Dear Dr. Sears: Thank you so much for referring this very pleasant gentleman, whose problem was that of progressive dyspnea, associated with diffuse radiographic pulmonary infiltration in volving primarily both lower lobes and pleura. You had been taking care of this patient primarily because of an intercurrent respiratory tract infection but the patient felt that progression of symptomatology perhaps signified an underlying, progressive dysfunction of unknown etiology. On admission, questioning revealed that he had worked with Dow Chemical for many years and been exposed to a variety of irritating gases but, in addi tion, had been involved in handling sheets of asbestos and been present in the environ ment when these had been handled and considerable amounts of asbestos dust was in the air. This exposure has been off and on for the past twenty to thirty years. In addi tion, he is a moderately heavy smoker and had complained of relatively recent increase in the amount of cough and sputum production. As you pointed out in your work-up, some respiratory dysfunction was present as long as thirteen years ago, at which time he was evaluated both at St. Joseph's Hospital and M. D. Anderson, with removal of several hundred cc's of serosanguineous pleural effusion but no definite evidence of malignancy. No tissue-diagnosis was made at this time but the possibility of tumor was excluded for the patient. Physical examination at this time revealed a modestly obese, anxious, mildly dyspneic, white male in no acute distress. There were bibasilar rales and decreased breath sounds at both bases. No evidence of cor pulmonale or clubbing was present. Review of chest x-rays revealed that both in 1972 and at the present time, there were rather dense, interstitial increase in markings with slight honeycombings in both lung fields, primarily at the bases, with dense pleural thickening and some pleural calcification mi msi smd 7# ewritW m.h--Matt. 23:36 particularly in the left hemidiaphragm. % i This picture most closely resembles the distribution ofasbestosis and, in order to both make the diagnosis and exclude the possibility of an underlying carcinoma, the patient underwent transnasal fiberoptic bronchoscopy. This was carried out under local anes thesia and was well tolerated by the patient and revealed essentially clear airways with no evidence of interbronchial lesions. Slight bronchospasm and mucosal erythema was noted. A transbronchial lung biopsy was performed under fluoroscopy and tissue ob tained from several subsegments of the right lower lobe all showed interstitial fibrosis. In addition, an alveolar lavage was obtained and cytological examination of the cells revealed multiple ferruginous bodies, diagnostic of asbestos. No positive cytologies were obtained. Pulmonary function studies, a copy of which is enclosed, revealed the presence of combined modestly severe restrictive ventilatory defect, with the superimposed presence of mild airway obstruction that does not seem to respond to bronchodilators. The remainder of the work-up was basically non-revealing. Under these circumstances, I would feel fairly certain of the basic diagnosis ofasbestosis with both pleural and interstitial fibrosis. In addition, there is some superimposed airway disease, probably related to cigarette smoking, that does not seem to be particularly re versible with bronchodilators. The extent of pulmonary dysfunction more than adequately accounts for the patient's symptomatology. He is therefore entitled to some amount of disability and/or compensation. I have made aware of his diagnosis and extent of disability. I suggested to him that, although there is very little directed therapy to reverse the underlying disease process, he should avoid environmental pollutants, stop smoking and continue to remain as active as possible with exercise up to tolerance, and a certain amount of weight re duction. He will be returning to your care and has requested me to give him a copy of the letter I am sending to you. Thank you very much again for allowing me to help you with this very interesting patient. Sincerely yours. ST053200! PMS/ej cc: Paul M. Stevens, M.D. Professor of Medicine Baylor College of Medicine