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Chevron Standard Oil Company of California 225 Bush Street, San Francisco, CA 94104 G. W. Richmond, M.D. Medical Director W. T. Kelley, M.D. Assistant Medical Oirector Medical Department May 10, 1974 Proposal for Study of Refinery Workers Exposed to Asbestos H. A. Sinclaire, M.D. Medical Director Mobile Oil Corporation 150 East 42nd Street New York, NY 10017 Dear Dr. Sinclair: I have reviewed the enclosed and it is my feeling that the Disher proposal is far too vague and too expensive, and in addition I am not sure where he could find 3000 workers definitely exposed to asbestos. I believe the Tabershaw-Cooper Study would be more in line with what API would be interested in. Inasmuch as we are doing a similar study in our own refineries, which is almost parallel to what Tabershaw-Cooper recommend, and also in view of the fact that our Richmond Refinery was involved in both the mortality and morbidity studies, which were done recently by Tabershaw-Cooper, I doubt if our management would agree to participate in this study. I am sure that when we finish our own study, Tabershaw-Cooper would be welcome to a copy of the results. Sincerely yours, GWRrgs Enclosure G. W. Richmond, M.D. m 1s PLAINTIFF'S EXHIBIT MBL-77 44?3e3 PROPOSAL FOR A STUDY OF REFINERY WORKERS EXPOSED TO ASDESTOS INTRODUCTION There is ample documentation to show that many workers exposed to insulating materials develop pneumoconiosis and that they have a high incidence of lung cancer and other neoplasms associated with the inhalation of asbestos (Leathart et al; Selikoff; Cooper and Balzer; Tabershaw, Cooper and Balzer). Balzer and Cooper included workers engaged in refinery construction in their studies of the levels of exposure to asbestos. Both asbestosis and malignancies may not appear until many years after brief but heavy exposures. For these and other reasons, we think it is prudent for refineries to define their worker populations who are potentially exposed to asViPRfftft anH t" n H o f" p n# Tjhorhpr nr on ^ ^Kara o SVidsr.C. 0 asbestos-related disease in those who have been exposed. Useful information may be forthcoming to some extent from the American Petroleum Institute (API) long-term mortality study. Negative information from the mortality study may not be conclusive, however, in view of the dilution of asbestos-exposed workers by a large population that was not exposed, i.e., those actually exposed to asbestos are not identifiable. TABERSHAW/COOPER METHODOLOGY We feel that a practical approach would be to perform a crosssectional survey of individuals who are directly exposed to asbestos, and others indirectly exposed (i.e., in jobs that require them to work in areas near those where asbestos work is going on) , to determine the prevalence of changes indicative or suggestive of asbestosis. Our review of chest films of insulating workers in the San Francisco areas shows clearly (See Table) that many exhibit positive findings. 05594 447364 2- - Table Analysis of Chest X-ray Films Period of Entering Trade 1906-1910 1911-1915 1916-1920 1921-1925 1926-1930 1931-1935 1936-1940 1941-1945 1946-1950 1951-1955 1956-1960 1961-1965 Total No. Available for X-ray Films 0 2 8 7 19 17 49 117 61 69 74 57 480 No. Having X-ray Film(s) 0 2 5 3 13 13 41 101 47 57 55 49 386 No. with Definite Changes Consistent with Asbestosis No. Z 00 2 100 5 100 2 67 8 62 6 46 17 41 33 33 12 26 5 0 24 12 93 24 The absence of such findings would be very reassuring to the individual firm as well as to the industry. A cross-sectional survey would provide information which would indicate whether or not a problem exists, and would also define a population which could be the subject of ongoing follow-up, without the need of plant identification. The plan for such a study is detailed in the following paragraphs. STUDY PLANT The survey logically falls into five phases: I. Definition of the population to be studied; II. Development of detailed instructions and forms for use by participants; III. Performance of examinations and tests; IV. Interpretation of tests and analysis of data; and, 447365 -3- I I V. Preparation of final report. PHASE I. DEFINITION OF THE POPULATION TO BE STUDIED A. Planning Meeting After authorization to proceed, members of the Tabershav/Cooper Associates, Inc. (TCA) project team would meet in a mutually agreed upon location with representatives of participating plants. We anticipate that five (5) plants will be involved, representing approximately 3,000 employees. The purpose of the planning meeting will be to: (1) Establish lines of communication and coordination; (2) Discuss the format and content of a questionnaire to be completed at each plant. (3) Agree upon a schedule for information flow, plant visits by TCA personnel and all other major milestones. B. Environmental Information As part of the information required for the study, each participating plant would Inform TCA (in a prescribed format) of those plant areas regarded as potentially hazardous; provide quantitative measurements of airborne asbestos (if available); describe the use of materials containing chrysotile and arooslte; and, estimate the degree to which there has been recent substitution of fibrous glass or mineral wool for asbestos Insulation. Other environmental data, as appropriate, also may be requested from the plants. C. Listing of Population In addition to the environmental data, each plant would provide TCA with: 1. The names of all employees currently engaged in the application, repair or removal of insulating materials including sprayed asbestos materials; and, 2. The names of all employees who work in areas where the above cited operations are performed. 05596 447366 -4- 3. For all employees identified above, a brief history including date of birth, date of hire, date(s) when possible exposure to asbestos began or ended. PHASE II. DEVELOPMENT OF INSTRUCTIONS AND FORMS Given the complete and accurate listing of personnel, TCA will develop standard forms for medical history, physical examination, and laboratory reports on each person. This will assure comparable data and results for the populations at each refinery. The forms will Include: (1) Detailed occupational history; (2) Standardized smoking history; (3) Standardized history for dyspnea; (4) Examination of lungs with special attention to evidence of rales and thickening of pleura; (5) Uniform examination for el'ihMng of fingers; (6) Pulmonary ventilatory tests to determine forced vital capacity and forced expiratory ventilation; (7) Chest roentgenograms by techniques designed for maximum detection of early pneumoconiosis; and, (8) Use of UICC/Cincinnati classification system films. So as to assure further the uniformity and comparability of results, staff members of TCA will visit each plant site to discuss methodologies with the medical department. This will include, for instance, instructions on the use of the forms, discussions about the quality of radiography, preview of examinations procedures and the like. PHASE III. PERFORMANCE OF EXAMINATIONS AND TESTS There are two logical alternative methods for performing the actual physical examinations and tests on the population. The first, and the one we recommend, would be for each local refinery, in its own medical department, or by arrangement with local physicians and laboratories, 05597 447367 to accomplish the tasks. The use of TCA forms and instructions would provide uniformity of results. The medical data would then be forwarded to TCA medical personnel for interpretation and inclusion in the final report. The second method would be for staff members of TCA to visit each refinery and carry out part or all of the examination. This method might increase somewhat the uniformity of results but would be considerably more costly. In our schedule and cost section, we have assumed the first method as being acceptable to all parties. PHASE IV. INTERPRETATIONS OF TESTS AND ANALYSIS OF DATA Tabershaw/Cooper Associates, Inc. would interpret all chest films. As part of this service, interpretations (without knowledge of exposures) would be made by a radiologist identified with the development of the UICC/Cincinnati classification and major consultant to NIOSH. All information would then be analyzed and employees would be grouped by age, length, and intensity of potential exposures to asbestos. These characteristics would be correlated with x-ray classifications and pulnonary function results, as well as physical findings and symptoms. From these results it would be possible to determine how the groups compare internally and how they compare with other populations who have had asbestos exposures. PW4SF V. pPJi?ARATION OF FINAL P.EPQP.T At the conclusion of the study, a first draft of a report would be prepared for review by representatives of the participating plants. Following such review, the report will be finalized and thirty copies made available to the review committee. The report will include the following: (1) Background discussion; (2) Copies of procedures, instructions, the questionnaire, forms etc. (3) Tables summarizing the data; (A) Discussion of conclusions reached by the analysis; and (5) Recommendations as to the number of individuals needing specialized periodic followup and the nature of such followup action. 05599 447368 TCA PERSONNEL This project would be under the direction of Dr. W. Clark. Cooper and would include the support of our professional staff such as board certified physicians, registered nurse, statistician and epidemiologists. Resumes of all personnel, and the background of TCA, are included for your information. SCHEDULE AND COST We think the study can be completed within twelve (12) months from the data of authorization to proceed. Our estimate for the timing of each phase is as follows: Phase I Phase II Phase III 3 months 2 months 4 months Phase IV 1.5 months V ^ liiwubua This requires timely action on the part of TCA and the participating plants. To assure milestone definition, a detailed schedule will be established at the Phase I planning meeting. Our price for the complete study is $71,325. This includes professional labor, travel, x-ray interpretation and all other costs associated with the completion of the project. 05599 447369