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MEETING WITH IRVING J. SELIX07T THURSDAY - NOVEMBER 13, 1982 Dr. Salikoff and I reviewed the Du Pont Guidelines for Physicians sections which partain to asbestos-related finding*. Ha stated that using X-ray findings as the entry point wa* logical because scat case* will show X-ray changes relatively aazly, even though sosie My have parenchymal disease without x-ray evidence. These latter cases will, however, have an increased risk of disease and usually show clubbing, rales, cyanosis, and dyspnea. He generally agrees with our categories of Benign Asymptomatic Abnor malities, Benign Symptomatic Abnormalities, and Malignant Disease, because it keeps the categories in medical terms, not legal terms. He believes, however, there can be minimal parenchymal fibrosis and no true disability, hence there should be a category for this under Benign Asymptomatic Abnormalities. He says there is no esbestos-relaead condition of Exudative Pleural Thickening, but there is Excessive Pleural Thickening which can be fatal. The term "Exudative'' should be changed to "Excessive." Cancers of the kidney and oropharynx should be added under the Malignant Disease category. All of these changes should be made on the next revision of the Guidelines. we then discussed Du Pont's voluntary handling of eases of occupational asbestos-exposure abnormalities as shown on the attached flow chart. He agreed with our procedure and readily recognised where we would have trouble because of the imprecision in dettrmiaiag percent of disability. He asked if we would consider giving some dollar award even for 0* disability, as a show of good faith. I indicated it wee not out of the question, but was unlikely because of the difficulty we would have in treating all employees fairly and equitably in the many different states and localities where we operate. Ha is anxious to establish some criteria which can be used to ascribe percent of disability irrespective of where the person lives or works or which pulmonary disease specialist avaluatas him or bar. He has completed a study of 2,000 asbestos-exposed workers using the AMA criteria, tha MBC criteria, and a double-pronged (leisure and work) 12-point criteria developed at Kt. Sinai, but doesn't yet have the data analysis completed. DU 037093 DUP 0935571 -2- W* eventually got into a discussion of workers compensation and tort laws and I than explained th# unique natura of Oalawara law and tha problems wa ara having. Ha readily recognized and understood the problem and indicated a willingness to help. Ha has agreed to have our pending Delaware cases evaluated at Ht. Sinai and ha will be involved with each case and his name will be associated with each. Ha was not firm on this, but indicated he generally will not testify, butt someone from Mt. Sinai will. His stated reason for not testifying is that he does not want to have to answer questions such as "Should Du Pone have known sooner that asbestos was bad?, etc." He believes there is a big need to establish criteria for deter mining tha degree of disability from asbestos exposure and wishes to assign about 2+ people to work full time to review all current procedures on disability evaluation for pulmonary disease. As results can be used to set internal standards for himself and members of his staff and possibly for others. His overall reaction to our request is yes, ha will help us. Ha pointed out that our program will make other companies look bad. I responded we had considered that, but we had an obligation to do what was right and proper for our employees and, after all, some company had to be a leader. Tha theme throughout our discussion was our desire to do what is right and proper for our employees and our wish that they recognize this and not feel we were showing peer faith. We agreed to continue the diacuaaion of the workers compensation issue of ambeatea-expoaed employees on Monday, November 22, at 9:00 a.m. with me, Du font workers compensation attorney (A. G. Burton), and Du Pont Assistant Medical Director (I. w. Culpepper, M.D.). I left a copy of the Ou Font Guidelines for Physicians sections for handling occupational injuries and illnesses and those for asbestos-related abnormalities, tha flow sheet of our procedure for determining percent of disability and tha appropriate compensation, and A. G. Burton's summary of Delaware workers compartsatl on law for asbestos abnormalities. He is to give me suggestions on the Guidelines sections. BiK:cab 11/11/82 DU 037094 OOP 0 9 3 5 5 7 7