Document nkLLLnq2Lz88qM47oqZ8yy9LR

ax'RINGFIELD MEDICAL ASSOCIATE^. INC. 2150 MAIN STREET SPRINGFIELD. MASSACHUSETTS 01104 TELEPHONE (413) 739-5676 Michael P. Coppola. M.D. CHEST DISEASES AND INTERNAL MEDICINE Frederick a. Flatow m.D. HEMATOLOGY, ONCOLOGY AND INTERNAL MEDICINE Pall C. Hetzel. M.D. ONCOLOGY, HEMATOLOGY AND INTERNAL MEDICINE Robert P. Hoffman. M.D INFECTIOUS DISEASES AND INTERNAL MEDICINE Thomas J. Keenan. M.D. CARDIOLOGY AND INTERNAL MEDICINE Daud H. Miller. M.D. RHEUMATOLOGY and internal medicine David L. Pleet. M.D. GASTROENTEROLOGY AND INTERNAL MEDICINE Thomas F. Race. M.D. GASTROENTEROLOGY AND INTERNAL MEDICINE Michael H. Rosen M.D. HEMATOLOGY. ONCOLOGY. AND INTERNAL MEDICINE Mari RyCZak, M.D INFECTIOUS DISEASES AND INTERNAL MEDICINE Roy Stillerman M.D. chest diseases and internal medicine May 3, 1983 Attorney James H. Tourtelotce Robinson, Donovan, Madden & Barry p.C. 1500 Main Street - Suite 1400 Springfield, MA 01115 RE: John H. Warren Dear Attorney Tourteiotte: Mr. John H. Warren was first seen in consultation June 3, 1987 at the Baystate Medical Center. The consultation was requested by Dr. Arthur McGuire following Mr. Warren's admission wi-th neurologic symptoms. A CT scan of the brain had been done showing multiple metastatic lesions to the brain from an uncertain primary. Mr. Warren reported repeated episodes of hemoptysis, and chest x-ray also showed multiple metastatic lesions. There were episodes of gastrointestinal bleeding and hematuria suggesting abnormalities in the urinary and gastrointestinal systems. Mr. Warren also complained of pain in the right upper abacnien ana lower chest, ana scans showed an abnormality in the liver and first interpreted as a benign hemangioma. Mr. Warren gave a history of exposure to the chemical vinyl chloride over a period Qf many years at his place of employment. Given the known association of vinyl chloride exposure and angiosarcoma of the liver, this lesion was suspected in Mr. Warren's case. Therefore a needle biopsy of the lesion in the liver was undertaken, but this was not diagnostic. Therefore on June 26, 1987, an open biopsy of the left lung and pleura was done revealing a malignancy diagnosed as angio sarcoma metastatic to lung and pleural. The known lesion of the liver was then considered to be the primary site. The hematuria and blood loss from the intestinal tract were assumed to be due to metastatic lesions to these organ systems. Mr. Warren was seen in consultation at the Dana-Farber Cancer Center in Boston. After review of the biopsy material and examination of Mr. Warren, the consultants concurred in the diagnosis of metastatic angio sarcoma and recommended chemotherapy. Chemotherapy was not successful UCC 081372 Sr-RINGFIELD MEDICAL ASSOCIATED. lNC. 2150 MAIN STREET SPRINGFIELD, MASSACHUSETTS 01104 TELEPHONE i4I3) '39-5676 Michael P. Coppola. M.D. CHEST DISEASES ANO INTERNAL MEDICINE Fredericx A. Flatow M.D. HEMATOLOGY. ONCOLOGY, ANO INTERNAL MEDICINE Pall C. Hitzel M.D. ONCOLOGY, HEMATOLOGY AND INTERNAL MEDICINE Robert p. Hoffman. M.D- INFECTIOL'S DISEASES AND INTERNAL MEDICINE Thomas J. Keenan. M.D. CARDIOLOGY ANO INTERNAL MEDICINE David H. Miller. M.D RMEL MATOLOCY AND INTERNAL MEDICINE David L. Pleet. M.D. GASTROENTEROLOGY AND INTERNAL MEDICINE Thomas F. Race. M.D. GASTROENTEROLOGY (YD INTERNAL MEDICINE Michael H. Rosen, M.D. HEMATOLOGY ONCOLOGY ANO 'NTERNAL MEDICINE Mary1 Ryczak. M.D INFECTIOLS DISEASES ANO INTERNAL MEDICINE ROY STILLERMAN M D. CHEST DISEASES AND INTERNAL MEDICINE RZ: John H. Warren -2t April 25, 1983 in controlling the metastatic lesions, and Mr. Warren continued to have hemoptysis and gastrointestinal blood loss with anemia. The brain mstsslHsss, which had responded previously to irradiation, recurred with return of neurologic symptoms. Despite blood transfusions, intra venous fluids and nutritional efforts, the disease progressed and Mr. Warren expired January 29, 1988. Angiosarcoma of the liver is quite a rare tumor, and it is my opinion that in Mr. Warren's case, there is a direct association between his angiosarcoma and his prolonged contac t with vinyl chloride. -- I / Sincerely, ' f ft hiMu fA> Fredericx A. Flatow, M.D. FAF/nbr UCC 081373