Document o9grDbQ86bw1g31g5rKGJx6KD

May 2, 1951 Dr. Ralph M. Stuck 1027 E . Amherst Englevood, Colorado ... ' ; Dear Doctor Stuck? . I have delayed writing to you concerning House Bill #277 until I could find time to consider it in some detail and also to submit it to some of my associates for their comments. The past several weeks have been filled with work clamoring to he done, and therefore more time has gone by than I should have wished. My comments vili take the form of criticisms of what is not to our liking, and therefore they may not be as constructive as they might be if we were capable of drafting an ideal bill. I recognize this as a very difficult task, and while I am critical of what has been done in some respects, I am not talking down to the Committee from any superior height of wisdom. On page 2 beginning at line 26 d. "Occupational Disease" is defined. I do not presume to know what is meant for legal purposes by"the rational" mind, but I think it is a mistake here not to put the emphasis on the medical interpretation. The laymans interpretation of cause and effect relationships is utterly incompetent here in many,if not most instances, and thus I should insert in line 1 page 5 after "circumstances" the phrase "and the available medical evi dence" - or words to that effect. On page 4 /line 22, I think the expression "might cause'such disease " opens the floodgate to an endless series of speculations concerning possibilities and probabilities. To my mind this is an invitation to one of the more serious errors of-medical testimony and judgment. This entire paragraph up to "Schedule" is'bad in its implications and in what It'vili lead to in hearings of this type. I should change it radically In -several^respects. The phraseology beginning in-line 2 1 :shepiid"uead? a as follows; /"---and (was) exposed to conditions of his employment" that -(were in fact capable of causing) such disease,-- -." The question is not - could the illness hive been occupational origin, by some stretching of the possibilities? - but rather it is - was it so in this case? In the same paragraph, line 25 and 26, it is wrong, I believe,'t o `require the employer to prove that* the employee does not have the occupational disease. He may or may not be able to do so, but the important thing here relates to whether or not the claimant acquired the disease under the conditions of employment provided by this employer. The nature of the conditions may have been such that the disease could not,-within Dr. Ralph H. Stuck - (2) - May 2,1951 \ . the limits of reasonable probability have been acquired. Such facts bear heavily on the correctness of the diagnosis, on the one hand, and the placing of responsibility on the other. Certainly the employer should be concerned, primarily, with the elimination'f hazard. Therefore, I should change this clause somewhat s follows* "enough evidence to establish the fact that the claimant (did not acquire the disease under the conditions of employment provided by the employer)." : A-minor error occurs on.page 5 line 17, In the misspelling of "pemphigus." The time .factor in both Beryllium Granuloma and Chrome intoxicatipn or ulceration,page 6 line 3 and 5, is much too short. The information on lead compounds, page 6 line 20 et seq, is largely incorrect or misleading. Lead poisoning does not occur among persons who handle tetraethyl'lead in the petroleum industry. ,No. case has ever been been among.persons who mix tetraethyl lead with gasoline. The hazard'is there, but the control has been adequate. Tetraethyl lead poisoning has occurred in Colorado only in connection with an abortive and misguided attempt on the part of novices to manufacture tetraethyl lead in a small improvised plant. The hazard of such, poisoning;exists in connection with cleaning large tanks used for the storage of leaded gasoline, but the control measures generally are adequate, and no such cases have occurred in Colorado. Lead poisoning has never been seen in the .S.A. in connection with the handling and use of leaded gasoline by filling station attendants, garage mechanics and refinery personnel.. Lead poisoning is quite rare among plumbers and almost non-exlsfcent among modern painters . Printers almost never suffer from lead poisoning.. It is possible but improbable, if the simplest canons of good, housekeeping are followed in printing establishments. The most common sources pf lead poisoning ln`modern industry are storage battery manufacture, -,brass foupdihg,'.Head 'burning, welding 'and burniif^ painted steel > lead smelting, manufacture of paint pigments, automobile-'body -manufac turing, pottery and glass manufacture The infration 'on..mercury is incomplete, as Is that .on most of the other sbatnGes. >jeacbIparaigrph tr. .should conclude with a clause which bakes in all,the 'us^a , as ili the cas of arsenic, page 6 line 1> 15, any other use of. (the element) r its. compounds." nVpge 8, 'in t i paragraphbegijining on line 8, some reference should be made to the combustion of bhe materials mentioned, as a source of oxides o f ,nitrogen. : , < -: V',\ v - Line 11 page 8 , 'speaks of poisoning by toxid hydrocarbons, etc., but only in connection, with, "the, general manufacture of chemicals." It would be well here t' expand* this little by some such means 3 the following; - "in the general manufacture and industrial use of Dr. Ralph M Stuck - (5) - May 2, 1951 .... solvents, Insecticides, plastics, and chemicals generally." In the paragraph beginning on line 20 page 8, the bladder tumor chemicals are misspelled - namely "benzidine" and "beta-napthyla- mine ." ' . . - ... '; ' , . . .- . On page 9 line 20, to fibrosis ." ahould be added "emphysematous b l e b s ." ^ . On page 10 paragraph C, beginning at line 20 makes no provision for beryllium poisoning, In which the lesions may not appear for some years after the end ofiithe occupational exposure vhich Induced the disease, nor for bladder tumor, In vhich the same situation obtains. ..... . ' . ; ';- ; .. - On page 12 paragraph a Is, I believe, utterly unworkable and also quite lacking in realism. It provides a refuge from liability for an inept and irresponsible employer. Nothing is clearer in the modern concept of Industrial hygiene, than the responsibility of the employer for the implementation of his regimen of industrial health measures by an appropriate supervisory and educational pro gram. Vhan this is done the problem referred to here doe3 not exist. When it is not done, it Is because of the ignorance or irresponsibility of the employer or his agents. I do not trust the mechanism by which the Kedioal_Reference Committee is set uo (page 16, beginning line 25) Perhaps I am unduly suspicious of this provision, but I should think it highly probable in most of the states with which I am familiar, that at least two of the three men who are to submit the list3 of professional committeemen, will have little or no knowledge of occupational ' diseases. I am not sure how you can go about it to avoid this difficulty, but I suggest that this procedure be reexamined carefully in the light of the situation within the State of Colorado. If this Committee is to serve a useful purpose, it must be made up of competent, sincere and experienced persons, whose appointments are based on their special qualifications and not on political (in the professional sense) preferment. I feel sure that there are such men available within the State, but there is no large number of them. Your problem is how to make sure that such men will be appointed. Almost everyone believes that a good reputable physician .Is capable of dealing with these problems of occupational medicine. The facts are otherwise, unfortunately, since only broad experience with occupational disease can yield competence in dealing with them. This Bill has many good points, in my opinion, and I should not want to give a contrary Impression by my criticisms. I trust that what I have said will be useful as constructive criticisms. ` Sincerely yours * f RAK ef /< Roberi A. Kehoe, M ). '