Document xjBGnLnYJb30O2rrog4EdeygJ

PLAINTIFF'S EXHIBIT AAR-16 FORTY-NINTH REPORT of the MEMBERSHIP of the MEETING MEOICAL OFFICERS held at the 8R0ADM00R HOTEL COLORADO SPRINGS, COLORADO February 18, 19, 20, 21, 22, 1969 j \ ; ` Published by the ASSOCIATION OF AMERICAN RAILROADS OPERATING-TRANSPORTATION DIVISION Staff Secretary 1920 "L" Street, N. W. Washington, 0. C. 20036 TABLE OF CONTENTS Pago Officers ............................................................................................... 5 Committee Personnel ........................ . ............................................ 6 Call to Order....................................................................................... 11 Welcome Address - Honorable Duke Dunbar, Attorney General, State of Colorado 12 Chairman's Message - Walter J.Longeway,M. 0............................. 16 "Physician Heal Thyself - Thomas M. Goodfellow, President, Association of AmericanRailroads .............................. 18 Briefing at North American Air Defense Command, Cheyenne Mountain................................................................................ 27 "Return to Duty of Cancer Patients" - Eric Ratzer, M. 0., Director of 3onfils Tumor Clinic, University of Colorado Medical Center ................................................. 28 Cardio-Vascular Evaluation for Return to Outy - Medical and Surgical - Panel Symposium ............................................. 41 "Basic Concepts of Disaster Planning" - Colonel Charles W. Upp, Command Surgeon, U, S. Air Force Academy Hospital, Colorado ........................................ ..... 85 Parameters of Periodical Medical Examinations - Panel Sym posium ............................................................... 89 "Role of Multiphasic Screening inDetectionof Disease" Donald L. Smith, Manager, Clinical Division, Technicon Corporation .................................................... 118 "Hallucinogenic Drugs - Their Use and Abuse" - Gerald Starkey, Jr., M. 0., Medical Coordinator, Depart ment of Safety and Excise, Denver, Colorado ... 135 Common Problems Conference - Panel Symposium ........................ 163 Address - R. R. Manion, Vice President, Association of American Railroads, Washington, D. C............................... 187 Report - Medical-Legal ................................................................... 148 Report - Medical Standards ........................................................... 199 Report - Trauma....................................................................................... 196 Report - First Aid 201 ) A 4 Association of Arer<';>o Railroads Unfinished Business ...................................................................... New Business .................................................................................. Adjournment...................................................................................... Attendance and Membership List............................................... P;oe 202 203 204 205 i i r i \ X \ i \ 4 4 i 6 Association of American Railroads MEDICAL SECTION, AAR Committee Personnel COMMITTEE OF DIRECTION (Terms Expire 1969) Stanley J. Cyran, M. 0., Director Medical Services, Penn-Central Railroad, 474 Penn Central Station, Phi 1aaeichia, Pennsyl vania 19104 Southgate Leigh, Jr., M. D., Chief Surgeon, Seaboard Coast Line Railroad, 3C0 Colonial Avenue, Norfolk, Virginia 23507 Walter J. tongeway, M. 0., Chief Surgeon, Colorado 4 Soutrern Rail way, 520 Metropolitan SuiIding, Denver, Colorado 30202 Abbott Skinner, M. D., Chief Medical Officer, Great Northern Rail way, 1350 Lowry Medical Arts Buildino, St. Paul, Minnesota 55102 Vance M. Strange, M. 0., Chief Surgeon, Southern Pacific Company, 1400 Fell Street, San Francisco, California 94117 (Terms Expire 1970) G. E. Dimond, M. 0., Acting Medical Director, Penn-Central Railroad, 508 Penn Central Terminal Building, Detroit, Michigan 48216 V. W. Hollo, M. 0., Chief Surgeon, St. Louis-San Francisco Railway, 906 Olive Street, St. Louis, Missouri 53101 William E. Mishler, M. 0., Chief Surgeon, Erie Lackawanna Railroad, 608 Republic 8uilding, Cleveland, Ohio 44115 John G. Sharpley, M. 0., Chief Surgeon, Central of Georgia Railway, 227 West 8road Street, Savannah, Georgia 314C1 Peter Vaughan, M. 0., Chief Medical Officer, Canadian National Railways, P. 0. 8ox 31C0, Montreal 3, Quebec, Canada (Terms Expire 1971) H. W. Haimatt, M. D., Chief Medical Officer, Chicago, Burlington 4 Quincy Railroad, 547 W. Jackson Boulevard, Chicago, Illinois 60606 Isadore Kaplan, M. 0., Director of Medical Services, Chesapeake 4 Ohio Railway, and Medical and Surgical Director, Baltimore 4 Ohio Railroad, Baltimore, Maryland 21201 Max P. Rogers, M. 0., Chief Surgeon, Southern Railway System, P. 0. 3ox 1808, Washington, 0. C. 20013 8. W. Stockwell, M. D., Chief Surgeon, Detroit 4 Toledo Shore Line Railroad, 1229-39 David Whitney Building, 1553 Woodward Avenue, Detroit, Michigan 48225 G. Earle Wight, M. D., Chief of Medical Services, Canadian Pacific Railway, Windsor Station, Montreal 3, Quebec, Canada f American 3ai1 roads L SECTION, AAR -<?e personnel :t y DIRECTION Expire 1959) -tor Medical Services, Dem-Contral intral Station, Phi 1 adeionia, Pennsyl- Chief Surgeon, Seaboard Coast Line W Avenue, Norfolk, Virginia 03507 ef Surceon, Colorado 4 Southern Rail* Building, Denver, Colorado 30202 edical Officer, Great Northern Railill Arts 8uildinc, St. Paul, Minnesota ' Surgeon, Southern Pacific Company, . Francisco, California S*il 1 7 Expire 1970) dical Director, Penn-Central Railroad, :inal 3ui1ding, Detroit, Michigan ecn, St. louis-San Francisco Railway, l' s, Missouri 63101 c geon, trie Lackawanna Railroad, , i. Iceland, Ohio 44115 Surgeon, Central of Georgia Railway, , Savannah, Georgia 31401 veal Officer, Canadian National ; .0, Montreal 3, Quebec, Canaoa Expire 1971) Meal Officer, Chicago, Burlington 4 *. Jackson Boulevard, Chicago, ' *f Medical Services, Chesapeake & al and Suroical Director, Baltimore '.re, Maryland 21201 Southern Railway System, P. 0. *-C. 2C012 "'on, Detroit 4 Toledo Shore Line i "itrey Suilding, 1553 Woodward !- 48226 1ra 1 Services, Canadian Pacific Montreal 3, Quebec, Canada Proceedings of Medical Section 7 COMMITTEE ON `'EPICAL STANDARDS J. G. Sharpley, M. 0. (CHAIRMAN), Chief Surgeon, Central of Georgia - Savannah 4 Atlanta Railway, Savannan, Georgia 31402 P. Vaughan, M. 0. (VICE CHAIRMAN), Chief Medical Officer, Canadian National Railways, ?. 0. Box 3100, Montreal, Quebec, Canada M. E. Childress, M. 0., Chief Surgeon, Western Pacific Railroad, Western Pacific 3uilding, 526 Mission Street, San Fran cisco, California 34105 S. J. Cyran, M. 0., Medical Director, Penn Central Railroad, -H 30th Street Station, Philadelphia Pennsylvania 19104 G. E. Oimond, M. D., Regional Medical Director, Penn Central, 409 Penn Central Terminal 3uilding, Detroit, Micnican cg216 R. W. Edmonds, M. D., Medical Director, Norfolk 3 Western Railway, Lake Region, Terminal Tower, Cleveland, Ohio 44101 0. L. Hansen, M. D., Medical Director System, Atchison, Topeka 4 Santa Fe Railway, SO E. Jackson Boulevard, Chicago, Illinois 60604 J. M. L. Jensen, M. 0., Chief .Medical Officer, Chicaoo, Rock Island 4 Pacific Railroad, Room 1023, LaSalle Street Station, Chicago, Illinois 60605 W. J. Longeway, M. 0., Chief Surgeon, Colorado 4 Southern Railway, 520 Metropolitan Building, Denver, Colorado 3C202 W. E. Mi shier, M. 0., Chief Surgeon, Erie-lackawana Railroad, 608 Republic 3uildirig, Cleveland, Ohio 44115 A. J. Sutherland, M. D., Oistrict Surgeon, Louisville 4 Nashville Railroad, 1904 Hayes Street, Nashville, Tennessee 37203 MEDICAL-LEGAL COMMITTEE Max P. Rogers, M. D. (CHAIRMAN), Chief Surgeon, Southern Railway System, P. 0. Box 1808, Washington, D. C. 2CG13 W. J. Longeway, M. 0. (VICE CHAIRMAN), Colorado 4 Southern Railway, 520 Metropolitan Building, Denver, Colorado 80202 Dave 8ishop, M. D., Regional Medical Director, Penn Central Rail road, Altoona, Pennsylvania 16603 G. E. Dimond, M. D., Regional Medical Director, Penn Central, 508 Penn Central Terminal 8uilding, Detroit, Michigan 48216 V. M. Hollo, M. 0., Chief Surgeon, St. louis-San Francisco Railway, 906 Olive Street, St. Louis, Missouri 63101 Southgate leion, M. 0., Chief Surgeon, Seaboard Coast Line Rail road, 300 Colonial Avenue, Norfolk, Virginia 23507 A. McEwan, M. D., Chief Surgeon, Northern Pacific Railway, 1515 Charles Avenue, St. Paul, Minnesota 55104 3. VI. Stockwell, M. D., Chief Surgeon, Detroit 4 Toledo Shore Line Railroad, 1229-39 David Whitney Suildinn, 1553 Woodwaro Avenue, Detroit, Michigan 48226 V. M. Strange, M. 0., Chief Surgeon, Southern Pacific Company, 1400 fell Street, San Francisco, California 94117 Association American Rai;roacs COMMITTEE 0;{ TRAUMA AND FIRST AID Abbot Skinner, M. 0. {CHAT) , Chief ``bical Croat -Northern Railway, I3SG Lcwry Medical Arts Suilni.-.g, St. Paul, Minnesota 55102 G. Earle Wig.nt, M. 0. (VICE CHAIRMAN), Chief of Medical Services, Canadian Pacific Ra'-way, Windsor Station, v:ntr:a; 3, Quebec, Canada H. W. Hair-.att, M. 0., Chief Medical Officer, Chicago, Curlington i Quir.cy Railroad, 547 W. Jackson Boulevard, Chicago, Illinois 60606 H. L. Hunter, M. 0., Chief Medical Officer, Illinois Central Rail- read, 5300 Stony Island Avenue, Chicago, Illinois 6C637 R. S. Kieffer, M. 0., Medical Oirector, Missouri-<ans<?s--ev.:s Railroad, 4^0 Girr.ioiin Road, St. Louis, Missouri 53147 COMMITTEE ON ENVIRONMENTAL HEALTH S. J. Cyran, H. 0. (CHAIRMAN), Medical Director, Penn Central Railroad, 474 30th Street Station, Philadelphia, Pennsyl vania 19104 Isadore Kaplan, M. D. (VICE CHAIRMAN), Director of Medical Serv ices, Chesapeake Ohio Railway, ana Medical and Surgical Director, ?altirore 3 Ohio Railroad, Baltimore, -Maryland 21201 M. E. Childress, M. 0., Chief Surgeon, Western Pacific Railroad, Western Pacific Building, 526 Mission Street, San Francisco, California 54105 V. M. Hollo, M. 0., Chief Surgeon, St. Louis-San Francisco Railway, 906 Olive Street, St. Louis, Missouri 53101 H. L. Hunter, M. D., Chief Medical Officer, Illinois Central Rail 5 t road, 5800 Stony Island Avenue, Chicago, Illinois 60637 P. D. Pretter, M. 0., Medical Director, Onion Railroad, 554 Linden Avenue, East Pittsburgh, Pennsylvania 1511- Max P. Rogers, M. 0., Chief Surgeon, Southern Railway System, P. 0. 8cx 1808, Washington, D. C. 2GQ13 Thomas Spears, M. 0., Chief Surgeon, Chicaco 3 North western Rail way, 127 North Clinton Street, Chicago, Illinois 60506 \ A. K. Sutphin, M. 0., Chief Medical Oirector, Seaboard Coast Line Railroad, 500 Water Street, Jacksonville, Florida 32202 Also, Chief Medical Director, Richmond, Frouerickscurg 3 Potomac Railroad, 3road Street Station, Richmond, Virginia 23220 G. Earle Wight, M. 0., Chief of Medical Sen/ices, Canadian Pacific Railway, Windsor Station, Montreal 3, Queoec, Canada f f!. ~ if Zs.ter: can Rai 1 roads v( trauma -Vio first aid -w.Vi), Chief '''ed'-cai O'^ics'*, Great \Lov/ry Medical Arts Building, St. : CHAIRMAN), Grief of "edical Services, 'jilway, ..`indsor Station, .'-'cntreal 3, ' Medical Officer, Chicago, Burlington 3 G`,7 a. Jackson Boulevard, Chicago, Mgdical Officer, Illinois Central RailAvenue, Chicago, Illinois 50637 ;.! Director, Mi ssouri-\ansas-Texas :iin Road, St. Louis, Missouri 53147 ,N ENVIRONMENTAL HEALTH <), Medical Director, Penn Central Street Station, Philadelphia, Pennsyl- CHAIRMAN), Director of Medical Serv> Onio Railway, and Medical and Surgical v 5 Ohio Railroad, Baltimore, Maryland of Surgeon, Western Pacific Railroad, ^'"'ng, 526 Mission Street, San 94105 on, St. Louis-San Francisco Railway, t. Louis, Missouri 63101 '"lical Officer, Illinois Central RailMjnd Avenue, Chicago, Illinois 60637 .i Director, Union Railroad, 564 Linden Pennsylvania 15112 r-:non, Southern Railway System, `^ntgn, 0. C. 20013 'r'r.'cn, Chicago 2 North Western Rail- Street, Chicago, Illinois 60606 v-iKal Oirector, Seaboard Coast Line ' .'.el, Jacksonville, Florida 32202 ''ctor, Richmond, Fredericksburg & vtrggt Station, Ricnmond, Virginia '''i'cal Services, Canadian Pacific `-' n. "cntreal 3, Quebec, Canada Proceedings of Medical Section 9 STEERING COMMITTEE V. M. Strange, M. 0. (CHAIRMAN), Chief Surgeon, Southern ?acif'c Company, 1400 Fell Street, San Francisco, California 94117 S. J. Cyran, M. 0., Medical Oirector, Penn Central Railroad, 47a 30th Street Station Building, Rhiladelchia, Pennsylvania 19104 Southgate Leign, Jr., M. 0., Chief Surgeon, Seaboard Coast Line Railroad, 3CQ Colonial Avenue, Norfolk, /irgima 23507 W. J. Longeway, M. 0., Chief Surgeon, Colorado 4 Soutnern Railway, 520 Metrooolitan 3ui1 ding, Denver, Colorado 30202 Association of AreHcan Railroacs As ex-Presidsnt Johnson said in his valedictory soeach, "We tried." 3ut I say, "We will continue trying one try even harder to do a good joo." In our audience is the man best qualified to advise us or where we are going. He is Mr. Thomas Goodfellow, Prssicsn: cf :-a Association of American Railroads. Mr. Goocfeilow chose as vis subject the topic, "Physician, Heal Thyself." It is :r.y honor and privilege to present to you Mr. Thomas Coodfcllow. ^Applause) MR. THOMAS M. GOOOFELLOW: Thank you. Dr. Longeway. Ladies and gentlemen: It's been said that insult, not flattery, is the great stimulator. How, then, can you expect much from me after a generous introduction like that? I'm pleased to be here--here in the shadow of Pikes Peak; here in Colorado Springs, a resort for health and pleasure; here with men who make a business of health and an art of pleasure; care with your ladies who lend grace, beauty and cnarm to the delibera tions of this body. I'm honored to be in such company. To orient myself to your group, I did a little homework. I skimoed through your "Proceedings" for '57 and '68. And I got the definite impression your meetings are really significant work sessions. I congratulate you on that. The "Proceedings" reported one or tv-c things I didn't fully understand. For example, I'm still not entirely clear on all aspects of "Flicker Fusion Freouency." 3ut I did understand tne bubble gum caper and the drunk test wnich cost one road 565,000 for just one blood sample. These reports were not meant to be funny-- but they did have amusing overtones for a layman like me. I'm fearful my remarks today may work the other wav around. Things I mean to be amusing may be taken seriously. Please do your best to differentiate the humor from the serious. That may not be easy. 3ut I'd like you to snow this is a Pavlcvian exercise. Your reactions will help me decide wnat to repeat at tne Railway Surgeons' meeting in Chicago in April--if anything. I understand many of you attend that meeting, also. Doctors are often harried but they almost always keep their wits about them. Here's proof: At a spot not far from nere, a few weeks ago, a bust of a world-renowned, living surgeon was unveiled with considerable ceremony. After the formalities, an attractive young woman said to the distinguished surgeon, "I'd like you to know I drove fifty miles on mountain roads in bad weather to see your bust unveiled." aticn cf American Railroads <*t Johnson said in his valedictory sceech, Ve will continue trying and try even o." ce is the .man best qualified to advise us on a 5 ^r. Thqmas Goodfellow, President of the o Railroads. Mr. Goodfellow cross as his ysician, heal Thyself." It is my nc.ror ana ; you Mr. Thomas Goodfellow. (Applause) GCCDFELLCW: Thank you, Dr. Longeway. .tlenen: It's been said that insult, not stimulator. How, then, can you expect much ,s introduction like that? be nere--here in the shadow of Pikes Peak; s, a resort for health and oleasure; here iness of health ana an art of oleasure; here nd grace, beauty and cnerm to the delioeram honored to be in such company. If to your group, I did a little homework. "Proceedings'1 for '67 and '68. And I got y meetings are really significant work :e j on that. ;s" reported one or two things I didn't sample, I'm still not entirely clear on all on Frequency," 3ut I did understand the * drunk test *hich cost one road $55,000 for These reports were not .meant to be funny-g overtones for a layman like me. remarxs today may work the other way : be amusing may be taken seriously, iferentiate the humor from the serious. .: I'd like you to know this is a Pavlovian will help me decide what to repeat at the in Chicago in April--if anything, I tend that meeting, also. n harried but they alirost always keep env's procF; At a spot not far from here, -f a wcr'.d-renowned, living surgeon was e ceremony, After the formalities, an :id to the distinguished surgeon* "I'd like ' miles on mountain roads in bad weather Proceedings of `'edical Section 19 Whereupon, the gallant doctor, with a gracious bow, said, "Yeung lady, I 'would drive a Hundred miles to do you a similar honor." (Laughter) Speaking of snowy mountain roads, 1 understand there's one a few miles *rom here with a sign that reads: "Ski Lodge Ahead. Twelve Doctors. No Waiting." I didn't come over mountain roads but I did come about 1500 miles. And now that I'm here I'd better exolain tie advance title for my remarks. I used the Biblical admonition, "Physician, neal thyself." I meant this to suggest that--we--all of us in the railroad bu$ines$--must do all we can to cure our own ills before seeking or expecting outside help or even understanding. With special reference to your section. I'd like to make serious but very brief contents on your history, ycur contributions, your weaknesses, your challenges, your work atmosphere, the impor tance of the railroads, your importance to the railroads, recent developments of special significance, and the railroad future. Your 1967 "Proceedings" has a history which reflects the significant contributions of this Section during half a century. I noted, for example, that Chief Surgeons were responsible for "The Sanitation of Privies on Company Property" at a time when such san itation was no small challenge. But times have cr.anged. Modern medical officers function on a very high level, and your Section can be proud of its history--and your collective record in your professional responsibilities. The new breed of doctors is not immune to lust for the buck. I know one young doctor who has already bought an estate. He calls it 3edside Manor. He's a throat specialist. He built up his bank account strep by strep. (Laughter) As you men know, many people call a doctor when all they want is an audience. My appearance here today is a switch. The audience called me_. Obviously, I'm no medical expert. My situa tion makes me think of a woman who burst into an office and blurted, "Doctor, what's wrong with me?" "Madam," came a prompt response, "you're too fat, you use too much rouge and lipstick, you bleach your hair, you smo*e coo much, and one other thing--you're in the wrong office. The doctor is next door. I'm a railroad freignt agent." (Laughter) Well, I'm not a doctor, either, but, like the freight agent. I'll tell you what's wrong. As I said, I can only touch cn a couple of topics. And I can't say anything too shocking because you won't get your cardiac lecture until tomorrow. So let me merely raise some innocent questions like: Have you sold your selves to management? Have you too much reverence for the status 20 Association of -msrlcan ?ai Iroads quo? Have you a co.munications problem? Do yc. believe in your selves and your industry? How`s tnat for openers? It's rny impression that rany M. O.'s wno wor`< for 'ailroads have never sold themselves to nanaceme.nt. 'ararercrt generally feels medical officers nave en-aged ~cst;y in ;ffor-tnofact wjQ'lcir.e. There hasn't been any widespread program of preventive .medicine in our industry. Or. if tnere nes, it's seen keot ',ec;-er. from many wr-o should have hoard about it. "is "as given rise to a conclusion that our doctors .nayen't cee'"1 jcecua.il/ concerned about the health of our employees. Instead, they've given tine and talents to employees after disease or accident nas manifested itself. This isn't a blanket condemnation. Some railroads have good programs. There are no douot favorable exceptions to every indictment I might make hare. And just as peoole wno need sermons least are usually the cnss in church, the worthy programs are no doubt represented in this room. But many of the cood examples remind me of a guy who winks at a girl in the dark. He knows what he's doing, but no one else does. I'm glad you come to meetings like this to share information about successful procedures. 3ut this still isn't selling management. Maybe new approaches are nseded--not necessarily in your professional work but in your promotional efforts. There seems to be a communications gap between you and the corporate brass, `iaybe the trouble lies in outmoded habits. Thir.k about it! Reverence for the status quo no doubt has advantages. 3ut we all need to be shook up once in awhile. I'd like to throw out a triple challenge. Are ycu con cerned mostly with the big wheels on your road? Or are you also looking after the health of assistant supervisors, assistant train masters, assistant finance officers and the whole second and third echelon who will some day have railroad destiny in their hands? Secondly, are you letting the brotherhoods assume concern for the welfare of employees below top level, thus beating us to the punch in an area which properly should be a major management concern? And, third, what are you doing to make yourselves truly indispensable to the railroad industry? I don't want any of this to sound like anything but erod ing questions. I won't presume to attempt answers. Ever, questions can be misunderstood. For example, a doctor, observing nis wait ress scratch her nose compulsively, asked, "Do you have exzer.a?" And she said, "?lo special orders, mister--just what's on the menu.1' (Laughter) Likewise, I want to stick with the menu and give no spe cial orders. By the way, I see your program menu calls for of American Railroads ,qn$ problem? Do you believe in your:ow's tnat for openers? that many M. D.'s who worx for rail ivc-r to management. Menage-rent cers have engaged rostiy `n after-the,, oeen any nicespread program of ndustry. Or, if tnere has, it's been ouid have heard about it. "his has .-at our doctors haven't been adequately f our employees. Instead, they've -ployees after disease or accident has at condeimaticn. Some railroads have : doubt favoraole exceptions to every And just as peoole who need sermons n church, the worthy programs are no -.pm. But many of the good examples ; at a girl in the dark. He knows what does. I'm glad you come to meetings on about successful procedures. But agement. ?$ are needed--not necessarily in your >r promotional efforts. There seems to -men you and the corporate brass. Maybe : h-^us. Think about it! Reverence dvantages. 3ut we all need to be .ut a triple challenge. Are you con-reels on your road? Or are you also jssistant supervisors, assistant trafn.-Hears and the whole second and third ;v* railroad destiny in their hands? itting the brotherhoods assume concern celow top level, thus beating us to 'openly should be a major management you doing to make yourselves truly : tr.-iustry? '-'is to sound like anything but prob10 a**errt answers. Even questions 3 doctor, observing his wait- y, asked, "Do you have exzema?" "-HI orders, mister-just what's on k with the menu and give no spe* ;pur program menu calls for Proceedings of `-'epical attention to the hallucinocenics :n Friday. I'm told these drugs create a world w.oere r/erytning is olurreo. unfamiliar or fantastic. But I wonder -what's so unusual about tnat. It happens to me every i.-e I misplace my glasses. Speaking of halluc'npgerics, I hear some pharmaceutical house has combined the pill with '.SO so young couples can take a trip without tne <ids. (Laugnter) Of course, several authorities, including some doctors, t-re saying certain drugs are less harmful than alconol. A medical student once asked Sir william Csler. "Is it true alcohol makes people able to do things better?" "Not at all," replied the famous doctor. "It just makes them less ashamed of doing them badly." Many of us in the railroad industry have been doing a had job with two important groups--our employees and the general public, with employees we've failed to generate a sense of excitement and optimistic enthusiasm. An atmosphere of gloom hangs over too many of our work force. And we've failed to persuade great segments of the public that we're not dead. The old debate question--"When is a ran dead?"--has been Honed to new flame by recent transplant techniques and publicity. Medical men believe the answer has .more to do with the brain than with the heart mscle. In fact, doctors know wrten a man is dead. But what about an Iron Horse? And how do you persuade an apathetic public that an Iron Horse is very much alive, but struggling against quicksand? We don't want to delay in finding remedies for our ills. I'm reminded of a doctor whose patient tofd him he'd gone to another physician. "And what's more," said the patient, "he told me your diag nosis is all wrong." "Is that so?" snapped the doctor. "Well, the autopsy will show who's right." Ooctcrs just can't win! I'm thinking of a patient who complained vigorously about his bill. "Listen," said the doctor, "if you knew what a sacrifice I made for you, you wouldn't be complaining." "What do you mean, sacrifice?" "My friend," said the doctor, "there's never been a case just like yours. If I'd let it develop into a post-mortem, I 22 Association of American Railroacs would have won worldwide fame." We can't afford to let the case of the Iron worse develop into a post-mortem. We must dc-velco a oetter understand!ng arc aporeciation for woat motivates employees. We -use `iid out r.y many employees have lost their perspective, treir sense of excite ment about the industry. And we must get ousy curing the ills we've already diagnosed in our industry. An old Arabian proverb says: "`lo .ran is a good physician who has never been sicx." And a bit of Latin wisdom advises tnat "the first step toward cure is to know w-nat the disease is. ' Co this basis, v.a should ce able to heal ourselves. We've nad our sick days, and we know wnat our troubles are. Our trouble isn't old age, although ye are venerable. This year we celebrate tne Centennial of the Golden Spike at Promontory, Utah. Sut we're not suffering from hardening of the arteries; and that's important, because railroads are the arteries of the nation's commerce, and they shouldn't be permitted to suffer deterioration of any kind. Railroads aren't on their last legs. But their situation isn't as good as reported in some magazines l reaa in my doctor's waiting room not long ago. I was greatly encouraged until I noticed the magazines were twelve years old; We do have one big thing going for us. Railroads are important, perhaps vital, to our farms, factories, forests, mines and other aspects of productive America because of the essential transportation service they render. But they also nave direct impact on the nation's economy through billions spent annually on wages, taxes, equipment, materials and supplies. I don't need to recite statistics on ton miles of trans portation service provided nor on the money spent in particular categories. You can read the details in the journals and other reference data of our industry whenever you like. Believe me, cur industry is mighty important as employers, taxpayers, customers am purveyors of transportation service. This importance is the core element in the story we must take vigorously to the public. If we believe in our industry, we've got to fan our story into every corner of the country. We've got to weld the railroads into a great organization. Ana .<e must render good service in a way that will win respect of the nation and patronage of customers. The key to our future is respected status in every community. You men of medicine do a tremendously important job in the discharge of your professional responsibilities. You can also co a great extracurricular job by helping sell our industry to tne public. You may not be aware of your major sales asset. Creoibility is the secret of successful selling. Doctors have high of American ?ai1 roads Proceedings of Medical Section re." let the case of tne Iron Horse develop t peveloo 3 setter understanding and ites employees. e rust f;nd out wny air perspective, their sense of excite'd ,,e rust cot busy curing the ills cur industry. ,<?ro says: "Ho ran is a good physician And a hit of Latin wisdom advises that is to know what tne disease is." On !e to heal curseives. We've had our our trouoies are. old age, although we are venerable. Centennial of tne Golden Spike at r not suffering from hardening of the j-.t, because railroads are the arteries rd they shouldn't be permitted to suffer * their last legs. But their situation n sore magazines I read in my doctor's I was greatly encouraged until I twelve years old. thing going for us. Railroads are . our farms, factories, forests, mines zive America because of the essential ''ncer. But they also have direct ft through billions spent annually on 'rials and suopl ies. `t- statistics on ton miles of trans:n tne money spent in particular r >tJils in the journals and other -ivnever-you like. Believe me, our t *. 'rcloyers, taxpayers, customers and .f'.ice. ! '** core element in the story we must if we believe in our industry, '" r''*r/ corner of the country. * ' ;*to 3 great organization. And we : *< t*jt will win respect of the ri.- < *y_ The key to our future is " `""'`^Q'-tsly important job in the .".iMlfties. You can also do ,* :-''T tell our industry to the , :-V;sr sales asset. Credi * '.< 11 jrg. Doctors have high credibility with the general oub: ic--deso: te what the Wall St^-et Caurnal said tan days ago aoout your oaa ;-age. I'm cdnviKceo Tu can ue of great help to the railroad industry, aocve and teyond' the regular call of duty. And : urge you to do so. You know about the restless, progressive activities in our industry--mergers, technology, diversification and so on. `-'any signs are good. Some signs are foreboding. We can capitalize on the good and fight the bad. But we must oe ready and willing to change our minds and our objectives on snort :tcttce. We don't want the Iron Horse to die because we stubbornly persisted in "treating" the wrong thing. 'rhe nodical Section of the AAR car. help treat the right things. You can help shape the future of our industry. Speaking of shape, have you heard of the wife who couldn't stick to a diet--and showed it? She know sne was losing her appeal and figured out a way to strengthen her will power. She pastea a Playboy pin-up on the refrigerator door as a reminder of the way sne wanted to be. It worked. She lost seven pounds the first month. But her husband gained eight pounds. He just couldn't stay away from the refrigerator. (Laughter) There were very exciting developments in medicine and surgery in the past year. Successful heart transplants started the year, l-dopa showed great promise with Parkinson's disease. Pos sibilities for a syphilis vaccine brightened greatly in '63. Prog ress was made in cancer research. Railroad developments aren't freighted with such direct human drama, but they've been exciting nonetheless. Our industry can have a very brignt and healthy future, especially if we achieve legislative relief for some of our ills rooted in outdated regula tory policy. But first, as I indicated earlier, we must do all we can for ourselves curseives. In other words, as it is written in LuEe. "Physician, heal thyself." Thank you. (Applause) CHAIRMAN LONGE'WAY: Mr. GoodfelTow, thank you so much for such an excellent address. You certainly helped show us where we are going. Now, so that the members of the Section will have time to really study the Committee reports, I have asked each Chairman at this time to very briefly--not over five minutes--give a resume of what he will present for action or consideration at the regular session Friday afternoon and Saturday morning. 24 Association of American ^ailroaos Or. Kaplan, Chairman of the Medical-Legal Ccmrn.if.ee, >'0 is Director of Medical Services of the CiO-C.SO, from Sal t'r-cre, Maryland, will lead off on this. DR. KAPLAN: Mr. Chairman, Mr. Goocfellow, 'adies and gentlemen: We have worked rather diligently during :ne o:st two :r three years to try to formulate seme final opinions ts to "ecice:legal affairs. I was hooeful that someone -`roa; the Legal Section would be here to represent them and perhacs give a fifteen-minute summery of their work. However, as yet : raven't seen anyone arc, if necessary, I will present such a report on Friday. The report will be presented in four different parts. Three-quarters will be devoted strictly to the medical oiase, and one-quarter will be devoted to the legal aspects. The first part of the medical will be a resume of the back study, whicn has teen in progress new for four years. It is practically completed, have a series of slides, which I am sure will be of great interest to the majority of you men and also to the ladies, because I have just been informed that the Renabilitation Unit of Cnicaco nas oeen given a grant of $100,000 to investigate the low back problem. Sc the back is not only a concern to the railroads, but is also bother ing individuals and other industries. The heart study will be of interest to everyone, and the results of Dr. Oimond's cases will be delivered by Dr. Cyran, inasmuch as Or. Oimcnd is unaole to attend. This will be the culmination of five or six years' work by Or. Qimond, who was supplied with material by the researen section of the AAR's Claim Department. It will give the relationship of heart problems in railroad workers to actual work and will be a precursor of work that is to be done in the future, in which we will attempt to correlate the effect of stress and strain on the work effort of railroad workers. We nave numerous recorded cardiac cases, and, if we can just apply them properly to the stress and strain proolsm, perhaps we can help our Claim and Legal Sections with one of its most vexing problems in the medical-legal field. Dr. Rogers is also going to give a dissertation on various multi-phased problems in the railroad industry, with an attempt at program computation. We have started some of this work alreacy.I I know that Or. Cyran of the Penn Central has programed some of his medical projects using computers. We have also utilised computers for individual programs, but unfortunately, there are so many other higher priority projects that Medical Department reauests for compute** time have invariably been indefinitely delayeo. Dr. Rogers has the backing of his company, and his railroad may actually be the first to pioneer an organized AAR meaical program. A suc cessful venture will give us a foothold on future projects which we can present to our various managements, with the hope that there will be a centralized type of computer working arrangements for specific medical study areas. I am quite cositive that this will, in the long run, save the railroad many, many thousands of dollars if ,,,-grican Railroads Proceedings of .''edical Section 25 i of the Medical-Legal Committee, who *$ cf the CJ0-330, from 3altfoore, is. irren, Mr. Goodfellow, ladies and vier diligently during the past two or :e sc'te final opinions as to medicalthat someone from the legal Section ct, and perhaos give a fifteen-minute -r, js yet I haven't seen anyone and, ;,,cn a report on Friaay. -esented in four different parts. ; strictly to the medical pnase, and the legal aspects. The first cart e of the back study, which has been . it is practically completed. I I am sure will be of great interest also to the ladies, because I have nabilitation Unit of Chicago has been investigate the low back problem. 3o to the railroads, but is also botherstries. The heart study will be of results of Or. Oimond's cases will be :h as Or. Dimond is unable to attend, f five or six years' work by Or. material by the research section of : will give the relationship of heart > ' 'al work and will be a precursor h tire, in which we will attempt ss and strain cn the work effort of rous recorded cardiac cases, and, if to the stress and strain proolem, r.d legal Sections with one of its ical-legal field. ng to give a dissertation on various ilroad industry, with an attempt at tarted some of this work already. if the Penn Central has programmed ng computers. We have also utilizoa 's, but unfortunately, there are so cts that Medical Department reouests j been indefinitely delayed. Or. ~pany, and his railroad may actually 'ted AAR medical program. A sucsothold on future projects whicn we :-ments, with the hope that there outer working arrangements for am puite positive that this will, ad many, many thousands of dollars ind may also give us a solution to the accident-orcneness problem, anc to tne individual variations of accident production. To conclude the Committee reports, 1 intend to surname very briefly what the Committee nas completed during tne past "'eo to four years. The new Qhei--'to will '-.eve ample work wren q nas peen adviseo regarding the list of projects wnicn are still ynder investigation. Thank you. CHAISMAH LCNGEUAY: Thank you, Or. Kaplan. The next is Or. Harold Hammatt, Chairman of the First Aid Committee. He is Chief Medical Officer of the Chicago, Surlington i Quincy Railroad, Chicago. OR. HAMMATT: Or. Longeway, honored guests, ladies and gentlemen: As Chairman of the First-Aid Committee and other mem bers, Or. Edmonds, Or. Hunter and Or. Kieffer, we have considered the possibility of revising a book. There is not a great deal of progress in First Aid. However, we have found a few minor cnanges ar.d vjs have printed this booklet, and every one of you nay pick up one of the bulletins on the registration table for review. On Friday afternoon we will place the booklet for vote as to publica tion, whether it is accectable for publication to replace the edition of July 1963 which was printed under the chairmanship of Cr. Olsen at that time. Thank you. CHAIRMAN LONGEWAY: Thank you. That will be on Saturday morning. Next will be Or. John Sharpley, Chairman of the Standards Committee, Chief Surgeon of the Central of Georgia-Savannah 5 Atlanta Railway, from Savannah, Georgia. OR. SHARPLEY: Or. Longeway, distinguisned guests, ladies and gentlemen: t have been asked to give a resume of the activities of the Standards Committee in five minutes. We have to review volumes, as Mr. Goodfellow brought out, and this is very difficult; in fact, it is impossible, out here goes. We will skip the interim meeting held in April for the time being, and also the one held in July. In the October meeting there was a report on the discus sion of the treatment of intervertebral disc lesions. Recommenda tions will be brought out on Saturday. Also, there will be recommendations that the subjects chronic angina, myocardial ischemia, be added with reference to inservice Class A employees, to the guide pertaining to myocardial WEDNESDAY AFTERNOON SESSION February 19, 1959 The General Session of the Medical Section of the FortyNinth Membership Meeting of the Association o' -rer-'can -.ai'rtvds reconvened Wednesday, February 19, 1963, at '.:20 o'clocn o.m., Oval Room, Golf Club Building, 3roacr,:cnr hotel, Colorado Spr'ngs, Colorado, DR. WAITER J. ICNGEWAY, Chairman. CHAIRMAN LGNGEW'AY: This session will now come to order. I sincerely hope that everybody enjoyed the trio to NORAS this morning. Personally, I thougnt it was wonderful ana instruc tive. (Applause) I will write a suitable letter to tne officers who briefed us. I want to introduce several guests here this afternoon: Mr. E. C. Ackerman, General Superintendent of the Colorado and Southern, and Mr. Williamson, Soecial Assistant, Southern Pacific Company, and Mr. S. P. Burton, Assistant General Manager, Southern Pacific Company. Gentlemen, we welcome you to this meeting. At an interim meeting it was suggested that we make a study of the status of cancer patients on railroads. It cian't take me very long to pick the man who could really help us. Our next speaker Dr. Eric Ratzer, was born in Illinois. As Greeley suggested, he came West. He, however, did attend CePaui University, Northwestern University, George Washington University with distinction. He has been assistant in surgery. University of Colorado and Cornell University, and now is Assistant Professor of Surgery at the University of Colorado. He is Executive Oirector of Bonfils Tumor Clinic, Univer sity of Colorado Medical Center, Oirector of the Head and Neck Service, Colorado General and Denver General Hospitals in Denver, and Oirector, Tumor Clinic, Denver General. He is Chief of Oncology of Veterans Administration Hospital in Denver. He has a very impressive list of publications. It is a distinct privilege to give you Dr. Eric Ratzsr. (Applause) DR. ERIC RATZER: I see Dr. Rainer is hare from Oenver, so I want to correct one thing. I am not Chief of Oncology at the Veterans Hospital. I applied for that job but so far that has eluded my grasp. So I want to correct that in the program, too. Also, in the program it says I am Assistant Chief of of -.rer1'can Railroads vt::-`sY --trnco.n session fcoruary 19, 1959 ^ssion of the Medical Section of ".he fortyr- of the -ssociaticn of American Railroads :o-r-jary 19, 1959, a* 1:20 o ` c1 o c '< p.m., .dicing, Sroadr.oor Hotel, Colorado Soring-,, . tCNC-WAV, Chairman. . *4r: This session will now come to order. tnat everybody enjoyed the trio to NCRAD \ t, \ thought it was wonderful and instruc'i -rite a suitable letter to the officers -r-ivce several guests here this afternoon: ':i Suoerintendent of the Colorado and : v.cn, Special Assistant, Southern Pacific :-rtco. Assistant General Manager, Southern clcone you to this meeting. -meting ft was suggested that we make a .i-cer patients on railroads. It didn't . the nan who could really help us. !>. Erie ftatzer, was born in Illinois, r ' -* >'est. He, however, did attend CePaui entity, George Washington University -eo assistant in surgery, University of ',,nlW, and now is Assistant Professor of Colorado. - ~"ctor of Bonfi1s Tumor Clinic, Univer">r, Director of the Head and Neck ', >r.v$p General Hospitals in Denver, ; >^nr General. He is Chief of " ''!--'*i'on Hospital in Denver. '"/-n;re list of publications. to gWe yQU Qr> Eric Rat2er> l" " !*ln<:r ** here `from Denver, so t. .**,"** -hief of Oncology at the - l'0*3 so far tf1at has :ht in ^ program, too. *'i I am Assistant Chief of Proceedings of Radical Section 29 --ery at the University of Colorado ''edical Center. I haven't '.ten that nign yet, either. Also, 1 am glad to be here because coming down it was -o.lly a job, I was driving a YW and I am afraid the neacwma was .',-ost faster tnan -my speed, i left Denver two hours ago, and it -"or-rjlly taxes about an hour to drive down. Sut ;t took me about - -our and forty minutes. ! was really getting nervous as ' was .-'.ting by the Air force Academy. My car didn't go over forty-five -!es an hour once during the trip and I had it cn the floor. Several weeks ago when Or. longewy called me and invited -v to talk to you on one "fenabi1itation of the Cancer Patient," or -ere specifically, '`The Return to Duty of the Cancer Patient," ! ;-.cepted without any reservation, feeling I couid handle tne suo:-:t without any problem, for the past five years I have been -solved almost exclusively in the care of cancer caf'ents--diag"jsis, treatment, and follow-up, which includes renaoi 1 itation-- .-j it would seem this experience would Qualify me for the subject, vewever, a few weeks ago wrien I began preparing tnis presentation, I began to have some doubts about my qualifications. I began to wonder if rehabilitation of a cancer patient as ! envision it applies when relating it to an industry such as the railroads. The use of artificial legs or the training of esepha:ea1 speech did not seem to me co bo the crux of the problem here, 'he problem seems to oe wnat occurs or should occur wnen evaluating 5 railroad employee for return to work with regard to the company's obligation to him, and perhacs more importantly their obligation to .remselves. This latter obligation can be difficult to define ccm;'ete!y as it includes things like stockholders, efficiency of nceration, safety, liability to society, etc. In order to accurately evaluate this last point, it is -ecessary to know a lot about the railroads and present-day railroading. This obviously includes the unions as well as management, current operating procedures, and so forth. On tnis point I am no exoert, so I went off to the Denver Public Library to look it up. Despite no little time there, I am still not an expert--the indus try is much too complex to learn in a short period of time. However, I was still committed to coming down here, so "'ere I am. Admitting the problem is complex and that I am not an expert in the knowledge of the railroad, which one must be to have answers to the problem, I have prepared this talk with the aim of raising questions that I think must be considered by you as formuUtors of medical policy for the industry when cancer patients are evaluated for return to duty. In your capacity as men responsible for medical policy, I would suggest you first must consider if the problem of the treated cancer patient is important, and if you so decide, the next step would be to try to set up guidelines on how to handle it. This latter project may not be too easy. 30 Association gf Arerican 9ailroads Now, since the oresentaticn that l have cr-anized will only take about twenty to twenty-five minutes ana since we are going tc deal in generalities, Or. Lpnceway succesteo that may:..- . the end if there are any specific questions referaole to the c. patient, the treated cancer patient, and a joo on ere railrcau, could hold then until then and then discuss thorn after the for-a! part of tne presentation. Each year in the United States we have 5CO,OCO new cases of cancer and there are acoroxirately 300,000 cancer ceatns. Assuming the railroads employ around a million neoo!e--trey ray employ more, I don't kr.cw--( estimate tne industry as a whole will find 3CC0 new cancer patients in 1959 and 1500 er-ioyees will lie of cancer. This may Pa a little bit slanted as most of the erolc/ees, or many of the employees of the railroads, are in the older age group, so you may actually come in contact with more than 33C0 new cases. Since you have about a hundred mroers in this group, each man conceivably could come in contact with thirty new cases of cancer in 1969. Many patients with cancer follow a rapid downhill course after diagnosis and treatment. They frequently have considerable pain and develop multiple ccmplications. Though palliation of these patients requires much time and effort, they rarely require evaluation for fitness to return to work. The subject for presentation this afternoon concerns the cancer patient who after therapy has been returned ohysically and emotionally to a state where he wants to go back to work. Whether or not he is cured and for how long he will remain well,, is not a prerequisite for evaluation of returning to work at that tine, .'t is important and probably will influence us in our decision as to whether he should return to work, but many patients who are not cured live for months, even years, and are physically capable of working for a long period of time. What should be done with these patients will also be your problem. It does not seem possible that this situation can be solved by rigid regulations, at least not and preserve the dignity of tne individual and allow all those people who can return to work to do so. Actually, since the problem is complex, it .may not be correct to say blanket regulations are improoer, because after analysis of all factors it may be decided that they are best for all concerned. As far as I know, the entire scope of this problem has not been elucidated, and until this is done it will be impos sible to make any specific recommendations. Currently, several factors must be evaluated when deciding whether or not a man treated for cancer should return to his former occupation. These factors include: the patient himself, the job he wishes to return to, the effect of the cancer therapy on the patient's ability to do that job, the responsibility of the rail road,^ the type of cancer the patient had .and its natural history. tion of American Pail roads Proceedings of Medical Section 31 presentation that I have organized will to twenty-five minutes ana pines we are lities. Or. Longsway suggested that ryg5 r / specific questions refereole to the care?iccr patient, ana a jeo on the railroad, .-a -an and tne.n discuss them after the formal n. e United States we have 600,OCQ new cases approximately 300,000 cancer deaths. 'ploy around a million oeoo!e--:hey may ,*--i estimate the industry as a whole vn',1 vents in 1969 and 1300 employees will die a little bit slantea as most of the employ, g/ees of the railroads, are in the older wally come in contact with more than OOCG .>e about a hundred Members in this group, .id come in contact with thirty new cases of :th cancer follow a rapid downhill course vent. They frequently nave considerable ? complications. T'ncugn palliation of -ucn tire and effort, they rarely require o return to work. presentation this afternoon concerns the y-apy has been returned physically and :e wants to go back to work, whether .r _w long he will remain well, is net a an of returning to work at that time. It ' will influence us in cur decision as to \o work, but many patients 'who are not ,firs, and are physically capable of of v*e. What should be done with these .r problem. possible that this situation can be "t. at least not and preserve the dignity v :!l :nose people who can return to work problem is complex, it may not be *' are improper, because after "' decided that they are best for ' w, the entire scope of this problem 'til this is done it will be impos"cvrordations. '.vy, must be evaluated when deciding ' / '.ncer should return to his former the patient himself, the job rf the cancer therapy on the ' . : o responsibility of the rat 1* t had zmd its natural history. _.* stage of the cancer at which it was treated, and the prognosis ' tre cancer in lignt of the cancer type and treatment. Again, I would like to stress that the problem of rehabil::t;on that will face you is not esophageal speech education in a jrvncectcree, or the use of an artificial limp in an amputee, but liter treatment, can a particular cancer patient return to work and .-at restrictions, if any, snouid be placed upon him. The patient himself is caoable of influencing our thinko on the subject to a large degree. We are all aware that deter--ied, highly motivated individuals will make every effort to '-.turn to work and very often are successful, whatever tneir '`jasens may be, I should hooe every reasonable ocoortunity is given v._-m to allow them to return to the job they wish. Almost all prev-r to return to their previous job'; but if this is not possible, ...natever the reason, perhaps other uses for their skills and i/periences can be found. The type of job the patient previously did must also be considered, especially if there has been some functional loss -.eccndary to the cancer treatment. Anterior resection for car cinoma of the sigmoid colon causes no functional loss and a person ;nould be able to return to his previous job regardless of what it was. However, a switchman who loses a leg from a soft tissue sar coma operation would be unlikely to be able to do his former job, no matter how well he could use his artificial limb or, for tnat matter, how well motivated he is. Many of our cancer treatments can affect the patient in such a way that he will be unable to do the same job as before, end colostomies after abdominal perineal resections are usually no problem, regardless of the job. But an ileal conduit after cystec tomy is not as easy to care for. A job which requires a great deal of physical labor and secondarily results in a iot of persoiraticn would make it almost impossible to keep the ileostomy appliance on. Laryngectomy may or may not influence a man's ability to do his former job. If good esophageal speech can be achieved, there is no reason he can't resume his old job. About half of these patients can learn good speech. They can learn speech well enough to talk on the telephone or, for that matter, I would say, use the short-wave radio. However, if there is any question about a patient's ability to do his former job, perhaps a trial period under supervision could determine his ability to do the work. When considering a particular person for return to work, the responsibility of the railroad to this employee, to the rail road itself, and the public must also be determined. It would be simple to say let all wno want to go back to work, work, but I don't believe this is possible. The company has certain obligations to the employee in maintaining his welfare, but it has options available to it in 32 Association o f iT:rican Railroads order to acnieve this obligation. In addition, the employee usu ally has tbs union to help protect his welfare. '<:hen ait thing* are evaluated, the patient can oe given nis old ;od oack cr La given a new job with comparable compensation, or ha can oe retir-so. Now, I have tnree slides that illustrate ry only contact with a railroad employee treated for cancer and wnat nas happened to him. (Slide) This is a 64-year-old man who was referred dev.w from South Dakota because of a recurrent basal cel; carcino~s of his nose, the bridga of his nose. He had had previous surgery, had previous radiation therapy, and now toe biopsy uncerne-'tn :.*e scab on the bridge of his nose revealed basai cell carcinoma. (Slide) He re-operated the patient and left him with this defect on the bridge of his nose. It is a through and through defect on the bridge of his nose. This man works, as far as I know, on the section crew of one of the railroads uo north, and I felt there would be no reason ha couldn't return to work. We gave him a snield. He didn't wan; to make a prosthesis or cover this by plastic surgery because of the recurrent nature of his cancer. There was some question about the margins of the incision. We wanted to be aole to exolore the defect readily so if recurrences did develop we could take care cf them promptly. it In fact, after this, about eight months later, he did \ \ develop a recurrence which required further resection underneath what looks like his left eye there. However, I had received sev sc; j eral communications from his railroad stating that they would prefer to retire this patient because he was 64 years old, ho was c going to retire in eight months anyway, and this, as far as I know, i is what happened to him. } ii I don't desire to get into whether or not they should retire the patient or not, or what their obligation should be as i far as he is concerned. However, ! don't think this man's ability to return to work was impaired. I think other reasons may hive entered into the railroad's decision to retire nim. He may have been fairly close to retirement age, anyway; maybe he didn't do a very good job, this was the easiest way to furlough him off, I don't know. But as far as his returning to work, there was no physical limitation imposed by his cancer treatment, and as far as his prognosis is concerned, I think it is still pretty good. as1' (May I have the lights?) Well, actually, I apologize for not knowing any more about this patient but probably as muen information as possible should have been collected in order to help make the correct decision as far as his management is concerned. If a man has a job, let's i t r- >;, r. of --or- can 3ai 1 roads Proceedings of Medical Section 3. -.Plication. In addition, the employee usu-'o protect his welfare. '..hen all thin-:; ant can be given his oid jqo Pack or be" jr-paraole compensation, or r.e can be Tavir-q rce slides that illustrate ry only contact e treated for cancer and wnat das napoenec is a 64-year-old man who was referred down te of a recurrent basal cell carcinoma of nis nose. He dad had previous surgery, -.s ferapy, and now the bicosy uncernsatn the s nose revealed basal ceil carcinoma. -operated the patient and left him with ,9 of his nose. It is a through and throucn nis nose. . as far as I know, on the section crew of north, and I felt there would be no reason -rk. We gave him a shield. We didn't want cover this by plastic surgery because of nis cancer. There was some question aoout ion. We wanted to be able to explore the -rrences did develop we could take care of j'* about eight months later, he did ;uired further resection underneath ?/. there. However, I had received sev'is railroad stating that they would . u>.'.t because he was 64 years old, he was -onths anyway, and this, as far as I know. o get into whether or not they should or -nat their obligation should be as .`>ver, I don't think this clan's ability irrd. I think other reasons may have ' . O'-cHion to retire him. He may nave "'v-nt ace, anyway; maybe he didn't da a - `--.sicst way to furlough him off, I . *'. returning to work, there was no '/ his cancer treatment, and as far as 4. i think it is still pretty good. t; .ionize for not knowing any more about . Tj'.-r. information as possible should * *'. 1 n r**pd. make fthhret co--rr-ec-t 1decision- as if a man has a job, let's t-.it is being phased out gradually by automation, and he -'year from retirement, it may be that, all other 'nines being ;t would be better to retire him early, { don't knew. Another point to consider in each situation is what will ... ,-a responsibility of the railroad wren and if recurrent disease .-..loos. Two areas need clarification here. There should not be any question of medical care for -- ijrrent cancer since most medical insurance covers :ne entire 1 -c-s3, and once the obligation has been assumed for this particu'r patient, it should pe continuous. 2ut to my knew!edge, tnere seen no definite clarification in an industry-wide sense of ..tsible relationships between certain occupations ano the taveioo,-fit of cancers, would there be any legal responsibility nere? p would this apply in any way to the development of recurrence? '"22$ this should be considered now ratner than wait until a ii'.ient claims his recurrence is due to aggravation by his job. .ince there are definite occupational hazards in seme industries, it example, uranium miners, aniline dye industry workers, this ,-ould be at least evaluated by the railroad. As far as l know, it unlikely any legal precedent has been set for any inoustry in is regard, but 1 oelieve it should be evaluated; ~ayoe it has -.-.-en, ["don't know. It should be evaluated in the light of not jcluding everybody who wisnes to go back to work, the opportunity :o go back to work. I think definite guidelines can be established, considering the patient as well as the rai7road. The second item under railroad responsibility concerns the risks assumed for the treated cancsr patient in case he is involved :n an accident. This applies to injuries he may receive, but also, more importantly, to injuries and damage he may cause. This seems *ost important for persons concerned with actual movement of trains. Recurrent cancer announces itself almost always in an insidious manner, that is, its symptoms and signs develop slowly over a rather prolonged period, and this allows proper investiga tion and treatment long before the patient is unable to do his job effectively. Only rarely does recurrent cancer manifest itself in a catastrophic manner, that is, unconsciousness or convulsion, or, for that ratter, sudden death. However remote suen an occurrence is. it would seem undesirable to me to have happen with a locomo tive engineer, especially if ha is working. Lung cancer and Tolanoma come to mind as possible types of cancer -where brain metastasis can be the first sign of recurrence. Usually there are warning signs such as lethargy and headaches, but in rare instances the first manifestation is convulsion. As admittedly rare as it is, the possibility must always be considered in evaluating a patient for returning to work. One other area that is related to this concerns the patient receiving chemotherapy for cancer. This rarely would 34 Association of American Railroads apply to those with extensive disease receiving drug therjov, as they usually do not feel like wording at all. 3ut at least* jt University of Colorado ``eaical Center, .-.e are starting cnerocr.erir as soon as possible on many patients who nave poor o^ognos's their cancers even thougn the treatment tney initially received has been for cure and there is no definite evicence of recurrent residual cancer present at the time of initiation of theracy. An example of this would be a Cukes' C adenocarcinoma of the sigmoid colon treated surgically by anterior resection. One month after operation w would start 5 -F'j and Ccurac'n ano con tinue this for an indefinite period. The five-year salvage :f these Dukes1 C carcinoma of the sigmoid colon is only 20 percent and the chemotherapy is added in hopes of improving this figure. The long-range effect of this chemotherapy given in a chronic way is presumed to be innocuous, out it is not known for sure. Just this morning I read in the paper about this ammonia cas cloud that killed eight people in Nebraska as a result of a derail ment of a train in Crete, Nebraska. I don't have any idea what the cause of the derailment was, out yet supposing someone wno was getting chronic long-term cancer chemotherapy was involved in seme way in the derailment, wnat would be the obligation of the railrp-o in this regard? I think before these situations do arise, possibly policies can be set up to handle either when they go arise or pos sibly to avoid having the situation coma up. At least one-fifth of the patients who are getting our chronic chemotherapy for the Dukes' C adenocarcinoma of the sigmoid colon really don't need it because they are cured anyway. In order to set up meaningful guidelines as far as the railroad and the cancer patient are concerned, two other factors must be considered. The first is the natural history of the par ticular cancer under consideration, and the second is the effect of the therapy on the cancer at the particular stage of disease it was treated. It is well known that lung cancer affects patients differ ently than skin cancer; it would not seem fair to apply the same rules and regulations to each when their long-range outlook and effect on the patient are so dissimilar. Also, a 1.0 cm. cancer of the anterior two-thirds of the tongue has a different prognosis than a 4.0 cm. cancer in the same area, especially if the latter has cervical lymph node metastasis. The former has a cure rate over 30 percent, the latter less than 15 percent, regardless of treatment. To apply the same regulations to each would seem unfair. As I mentioned in the beginning, this subject initially seemed simple and straightforward. 3ut, on closer inspection, I found this not to be true, and I feel reasonably confident you ;ociat'on of American Rai1 roads Proceedings of Medical Section 25 : extensive disease receiving drug therapy, : fee! like working at all. out at least at -ado Medical Center, we are starting cnemothe.-. on many patients woo have ooor prognosis f>tncugn tne treatment they initial!-' receivec :nd t.nere is no definite evidence of recurrent sent at the time of initiation of therapy. of this would be a Cukes' C adenocarcinoma of roated surgically by anterior resection. On? on we would start 5 -rU and Coumadin and con'definite period. The five-year salvage of >nora of the sigmoid colon is only 2C percent / is added in hopes of improving this figure. 3nge effect of this chemotherapy given in a umed to be innocuous, but it is not known for wrung I read in the paper about this ammonia gr ght people in Nebraska as a result of a dart:' Crete, .Nebraska. I don't have any idea what :: ent was, but yet supposing someone who was term cancer cnemotheraoy was involved in sc'ft, what would be the obligation of the railrod: think before these situations do arise, possib . up to handle either when they do arise or pos* eg the situation come up. ;e *'*th of the patients who are getting our the Dukes' C adenocarcinoma of the sigmoid eeu it because they are cured anyway. , set up meaningful guidelines as far as the cer patient are concerned, two other factors The first is the natural history of the par consideration, and the second is the effect r ancer at the particular stage of disease it was crown that lung cancer affects patients differ?r; it would not seem fair to apply the same ; to each when their long-range outlook and t are so dissimilar. cm. cancer of the anterior two-thirds of the t prognosis than a 4.0 cm. cancer in the sane he latter has cervical lymph node metastasis._ rate over 30 percent, the latter less than !' >f treatment. To apply the same regulations to cd in the beginning, this subject initially aigntforward. But, on closer inspection, I true, and I feel reasonably confident you reach the same conclusion. I am not sure the problem raised tnese patients is significant encugn to tna industry to warrant ,;ete evaluation, and this would seem to be the first thing tnat ..id be done. It would seem to me that the railroads themselves to determine how significant toe problem is to them. After -s nas been done, that is, after the determination of the problem been elucidated with all of its ramifications, then I should rk that possibly your group should set up a committee to try to --uiate some guidelines that could apply to the industry as a Thank you. (Applause) CHAIRMAN LOHGEWAY: The doctor will entertain questions rom the floor. Dr. Kaplan, do you have something to ask on this roblen? DR. KAPLAN: I don't have anything to ask. I might ccm--rt a little bit. Dr. Ratter probably isn't in the unfortunate ;sition of being the examining surgeon who is being forced to rcide whether or not the employee is able to resume duty. However, ..-are are so many extraneous factors that the medical examiner has :y consider, that you just can't establish any fixed policy. In the surgeon's opinion, the employee is able to return *o duty. However, a chief medical examiner may disagree, for many casons. First, the employee may work under a craft agreement .-ereby it is mandatory for him to retire at 65. Such being the :ase, he has but six to eight months more of working service. It s not unusual for an employee to claim that undue exposure to itrong sunlight over an extended period of time might be the ;\'Suonsible factor for a recurrence of a skin cancer. Or he might nntain exposure to some trauma while at work--a piece of ballast .'rock him in the nose, and as a result he developed a recurrence tne lesion. Looking at it from another standpoint, on our railroad we do not have a mandatory 65 retirement age and theoretically this -roloyee could work until he is 30 or more, if he is physically -jlified to do so. If he had been a good, faithful employee and '1 worked 40 years, had never given the claim department any foclems, and if his examining surgeon would recommend return to '`t-j status, we might discuss the case with his managing supervisor sr4 claim department. He could be considered able for duty, with understanding that, as a trackman, he would not be permitted to cut on derailments or train wrecks or work more than an average " sight to ten hours per day. Also, he would protect himself gainst excessive exposure to sunlight. So you cannot establish a fixed rule that an employee with 1 carcinoma can or cannot return to duty. It varies with each and v-ery railroad and with the individual nature and location of the clarion of American Railroads os, with words and cneciicais, especial 1, : cistraugnt men ranking non-neoical 3`' ns: (') Setween the scene of the dm--;2} Between the u'SAFA Hospital and tr.= 5 OSAFA hospital and surrounding sours:; (1) and (2) will break down quiev.w .ailable. (3) can be accomolisned wi:.- :rsg telephone operator.) (4) Sadie. spapers. ;2) Airplanes (especially helicopters), is, car rental agencies, private (every oulance), (4) Walking. :an and do help: The Red Cross, especial' Croups (Rotary, Kiwanis, Lions, etc.); .died, uninvolved adult and hign scnool *arers, police augmentees, feeding fact'.t Proceedings of Nodical Section ;9 FRIDAY MORNING SESSION February 21, 1369 The General Session was called to order at 9:00 o'clock -iday, February 21, '969, Cocoer Room, Broadmoor Hotel, * fe. *. 0. UMNff. General hi r- CKAIRMAN LONCE'HAY: This session will how come to orcer. The Symoosium this morning is very timely and a very ^nt one. So as not to lose valuable time, I -will present the .. The only thing, before I do F would like to announce rny. no is talking from the floor or asking a question, please *.;fy himself so that the reporter can get his name and the :-v of the railroad. "The Parameters of Periodical Medical Examinations." The :) will consist of Mr. E. T. Horsley, National Railroad Adjust: Beard, Division 1, Chicago, Illinois; Dr. C. R. Harper, M. D., - -r>ai Director, United Air Lines, Oenver, Coiorado; Or. C. Southern Pacific Comoany, San Francisco; Mr. James l.'olfe, President, Labor Relations, Chicago t North Western Railroad, ;ico, Illinois; and the moderator is Cr. Ben Stockwell, Chief .-goon, Grand Trunk Western. I will turn this over to Or. Stockwell. ... Or. Ben Stockwell then assumed the Chair... CHAIRMAN STOCKWELL: Thank you. Or. Longeway. You may notice that we are one man short. F understand vere is a bad snowstorm between Colorado Sonnes and Cenver and *- *re hoping Or. Harper makes it in time to participate in this 'ting. First, I would like to make a personal consent concerning ''? resting that we are attending. This is, J believe, the finest --`'Jng of the Medical Section of the AAR that 1 have ever attenceri. *``le I am sure we will coiment about the meeting ana what our `Jirran has done for us tomorrow, I did want to start off by say`J that he has done a tremendous job and we're all with him. Clause) It is a real pleasure to moderate a panel with such dis'>'* wished panelists, and as our Chairman has suggested, it is a ''vly subject. This is a discussion of preventive medicine and is our to the remarks of Mr. Thomas Goodfellow, the President of `-V AAA, who told us in his address on Tuesday that preventive ---i----- - i don't know of any so Association of American Railroads better way of tatting -'rto preventive .-.edicine in railway than through a good periodic medical examination program. The title of our nanel was suggested by a coed fr--mine, a linguist with a tremendous vocaoulary, and so 1 will start cut by asking Mr. Chick Horsley to cefine "Rara-^-.,.. Mr. Horsley. MR. HORSLEY: Thank you. Dr. Stockwell. I'd like to say first it is such a distinct privile^ me to be invited to attend a meeting of a group of your ore*':. My work is post-medical examination, post-litigation, and .-.n;, in the field of arbitration. Our decisions usually flow from ivy-covered brains, if I may say so, of professors of econcrii-. and such, so that I'm sure that such decisions nave teueneo if not all of you, at one time or another, and therein lias problem after the preventive steps by you have been taxed. I will get around to defining my concect of parameters a moment, but I would like to say that we are in the business .y custodial transportation of people and property, and in soite y all the technology, the cybernetics that we have engaged in in recent years, this business of transporting pecole hasn't :nry our character, which has been defined as an extraordinary oai':-? of the property and an extraordinary insurer of the lives an: safety of the pecole. So that this position of ours is still ccharged, in spite of the machines and computers, by men, employe and now to get to the real point, and that is, that the abilit,. these men, these employees, to discharge this ousiness under ys supervision of those appointed to that position, is owing to an appraisal by your exclusive profession of their ability to dis charge that business that we are engaged in. So that's most important, their ability to discharge it, and therein comes tea preventive medicine that Or. Stocxwell and President Goodfellcw spoke of. The parameters of periodic physical examination are the:.that it seems that I have had to ceal with in the past many years that I have been in this aftermath business, so to speak. These parameters are in the form of, let's say, questions. I don't think that a physical examination really is based upon any metric system but there are side measurements which is loosely wnat para meters mean to me--perhaps net to you gentlemen in the puristic sense. 8ut the parameters^ of periodic physical examination are best expressed in my eno of the business by such questions as, cr a man be examined at all unless tnere is permission to examine nv* in the collective oargaining agreement, and that is tne labor agreement--we will call it that for short. And the answer to that. I think, is very definitely that without the carrier having given it up, it is the carrier's not only prerogative but the carrier's obligation, in view of our character as bailee and insurer, to ?_tion of African 9_a i ]roa(jS r co oreventive ~>?dfcT 1 -r railway iodic meoicai examine or Program. jr pac.al was suggested by a .'.''erCaus vo<;3c>y; ^ry t .if.q no '.G fr or : ur. Chic* Horsley to define * tnir,/ P-3rair<3t' -"* you, Sr. Stockwei first it is such a distinct orivilece vi a resting of a orouo of your oro'-a-. craTination, cost-litigation, and wnol >-. Our decisions usually flow from ' -ay say so, of professors of economics .r* that such decisions rave touched ios-.. e tire or another, and therein iies tr.e tive steps by you have been taken. "d to defining my concept of parameters : " to say that we are in the business or r.f cec-ole and property, and in soice c* typemetics that we have engaged in in --: < of transporting ceoole hasn't cr.ar-gaj .`(.'t-n defined as an extraoroinary bailee <traordinary insurer of the lives and > that this position of ours is still dis- s and computers, by men, employee: ! nt, and that is, that the ability o* ,o discharge this business under the :".ed to that position, is owing to an ? profession of their ability to dis <',* are engaged in. So that's .post 'o discharge it, and therein comes the 'Stock-well and President Goodfellcw :-;ricdic physical examination are th< '{ to deal with in the past many yeai u-rryjth business, so to speak. These l-it's say, Questions. 1 don't * on really is based upon any metr' ;m-onts whicn is loosely what par r to you gentlemen in the puristic ' :<;riodic physical examination are cosiness by such questions as, c. '.'pro is permission to examine h -;, and that is the labor 'i'- 'cr short. And the answer to tht '*.hcut the carrier having giver *'/ prerogative but the carrier's ifi'.tc-r as bailee and insurer, to Proceedings of '-'edical Section 91 .w.. these pnysical aporaisals throuqn the activities of your pro...ssion. So tnat we may, unless we oargam it away, examine the The second question, the second parameter, one mignt say, .. -.ether or not ne may be examined after he comes back from an osence. The third is whether or not he may be examined after he ;$ peen discharged from private medical care. The fourth could be whether he may be physically exarr-od .anodically as a program of examination, annually or quacren- =1 iy, ;rc so on down toe line as to whether there should be a reasonable -.vision of this work of examining by age limit groups or by craf: :r class employee groups. CHAIRMAN $7QCK'*'ELL: Well, now, Mr. Horsley, as reluctant :s l am to interrupt such a fine speaker, we are going to ask you to elaborate on each of the points that you have mentioned in conttoerable detail as this panel develops. And in order to do that, o mat we will all get the most cut of it, -we are making tnis what jcu might call a workshop session, and we are going to ask that weryone in the room participate and ask you to interrupt, as I jst did in a very impolite way, ask questions or take exception to any of the remarks made by the panelists. I think this will raxe it (tore valuable for a!) of us and we ask your participation. To illustrate why we think this subject is timely and why the panel is being presented today, I can mention two things that nave'occurred. First is tna relatively toueny subject, as far as tne AAR is concerned; it is the National Transportation Safety Act of 1568. This was presented to Cong-ess by Mr. Alan Soyd, the Secretary of Transportation last year, and there was considerable feeling on the part of memcers of the AAR that this was very restrictive legislation. In the bill and in the letter of transmittal from Mr. ,?cyd to the Senate, there was no specific reference to physical condi tion of employees except this--and I will now quote from the letter of transmittal from Mr. 3oyd to the President of the Senate, h'uoerc Humphrey: "The Secretary would also have authority to regulate the qualification of rail employees as required in tne interest of safety." Now I am told tlut in the discussions of this bill, it was assumed by the people considering it that the railroads did have a suitable, proper periodic physical examination program to determine that their employees were able to safely perform their duties. It seems that this is probably a false assumption, and we will go into that a little bit more in a few minutes. 92 Association of American Rai',,_oads At this ooint I will ask Mr. Risendal to tell js present status of the bill is. 'n'e are ail aware of tne far* is a new Secretary of Transportation, vl'\ .'cite. We mow - Transportation Sill of 196G aS sicecrac-'ea ora do net what the present attitude is of tne Secretary of Transocr-.:-. As a man who has been in Washington a noon teal and is go'"- there in the future all the ci^e, possibly Mr. R:stnaal can us something aoout this. MR. RISENCAl: Doctor, I an net sure that ! can. some of these other gentlemen are bet*er informeo t'.an a-, asked that question last week. The answer I received was Department has prepared a new bill, the bill has oe:n pra$?r;.. the labor people but has not yet been presented to tne mcra-sgrouo for consideration or for review. I understand that -'r. Goodfellow has mace a request for advance copies of the bill ;a it is introduced but us not yet received it. So there is a ol What it says we don't know as yet. CHAIRMAN STQCKKELL: Thank you, John. The second thing that stimulated my personal interest this problem was something that occurred on cur railroad. Grant Trunk Western. The Srotherhood of Locomotive Engineers served with a Section 6 notice to limit the scone of our periodic medic: examination program, actually to eliminate it. I think at this point I will ask Mr. Wolfe to tell us what a Section 6 Notice is. Most of you knew, but I'd like to have him define it at this time. Mr. Wolfe. MR. WOLFE: Like Mr. Horsley, gentlemen, I want to thank you for the invitation to be here. I consider it a privilege anc I might say that I feel very comfortable among you. When i first graduated from law school and went to work I was assigned--! :.v>they didn't like me--they put me in personal injury work. After serving a tenure, which I enjoyed and which was extremely chaUerting, I might say, I then became a specialist in labor law anc =gr` was involved quite intimately with a number of the members of your profession. And I also have a father-in-law and brotner-in-i aw are doctors. So I feel quite comfortable in being here. To answer the question, a Section 6 Notice gets its title from the fact that it stems from Section 5 of the Railway Labor Act. All it is is siiroly a request by one party or the other to change existing contracts or practices. In other words, it locks prospectively to the future and seeks to make an affirmative or negative change in the rules or Dractices that presently govern the relationships between the parties. That's all it is. The Railway Labor Act establishes a series of procedures for those notices. We must have local bargaining on the property, and if that doesn't succeed, then either party may ask for the of American Panroads il! as< Mr. Risencal to tell us >*hat ; ;?. *'e are all aware of the fact t -.cortaticn, Mr. Voice. 'e ;:ncvf that *is sidetracked ar.d *e do rot knew <, of trie Secretary of 7rnscortati cn I'.'.rufiqtQfi a good teal ana is going to : titre, possibly Mr. Risencal can tel ' :tor, I am not sure that : can. ?err< --o are better infcrmeo than ! am, bu: The answer I received was that : t ';-v pill, the biii nas seen oresenteo - ,c been oresented to tna managemeo .< 'or review. I understand that Mr. t for advance copies of the bill be? . > yet received it. So there is a bil - i'. yet. : Thank you, John. *.Mt stimulated my personal interest ir o fit occurred on our railroad, Grand ' d of locomotive Engineers served us ifit the scope of our periodic raedica *1 :y to eliminate it. ! will ask Mr. Wolfe to tell us - wost of you know, but I'd like to * \ Mr. Wolfe. rorsley, gentlemen, I want to than \ consider it a privilege an .omfortable among you. When I firs i *ent to work [ was assigned--! thi '* m personal injury work. After ed and which '.-fas extremely chailei a specialist in labor law and ag. ith a number of the members of yoi 1 father-in-law ana brother-in-law v r-vwfortable in being here. a Section 5 Notice gets its " Section 6 of the Railway labc by one party or the other fUces. In other words, it k ! 'ft'ks tc make an affirmative c factices that presently gover '*. That's al 1 it is. '"`-iblishes a series of procedu * local bargaining on the prope `n either party may ask for the p roceedinqs of Medical Section 33 -vices of the National Mediation 2oard, and if that doesn't work, ?o arbitration may be orofferod, and if a-di'ration is rejected, - emergency board may be certified, and eventually you get to the ,-iat wnere one side or the other ray exercise sel`-relp. Seif- in the case of a brochernocd usual}/ means strike. Seif*ke"p - the case of a railroad means promulgating new rules or locking jt. CHAIRMAN STOCK'WELl: Thank you, Mr. Wolfe. Now, this specific Section 6 Notice that we were served .ith says, in the first two paragrachs, and 113T cuote because 1 -ink tnis is the crux of the proolem: "Paragraph 1. The preoer performance of duties by an engineer covered by this Agreement will be con sidered as a satisfactory test of his physical ability to perform suen service and such emoloyees will not be subjected to physical re-examination except as provided for in this Agreement." I think it is obvious this means we can't examine locomo tive engineers if we become a party to this type of an agreement. "Paragraph 2. At two-year intervals engineers who have not reached 60 years of age will be required to report to the company doctor for re-examinaticn as to vision, color sense and hearing only" (only, I stress only), "subject to Paragraph 1 of this Agreement." In other words, we were locked out, as far as making any periodic physical examinations of our own locomotive engineers. The procedure that develcos then is that a mediator, who is appointed from the National Mediation Soaro in Washington, pre sides over a joint meeting between the brotherhood and the railroad. On our railroad, when we have a discussion of a labor relations problem concerning the Medical Department, fortunately we are notified and we participate in it, and that's going to be one of the recommenaations, I think, of the panel: When your rail roads are having discussions of labor relations problems concern ing Medical Department matters, you will be notified and you will Participate. We have had two meetings with mediators, two different radiators. The first one resulted in no agreement and we were then advised that the Grotherhooo or' locomotive Engineers had the legal right--and we will ask for advice about that -rom other Panelists--the legal right to strike after 30 days. Of course, this is quite a club over the head of the railroad. Management became considerably perturbed at this point. They didn't want 94 Association of American i9r-oads the railroad tied up over a labor relations matter invol/ir Medical Department. However, with the second mediator, >hich was a '-y-.-. longed meeting, and tne Brothernood of Loccrotive cncinaa-: represented by tne G7W General Chairman ^s well as by na-.-v officers, we were able to prevail uoon tnem to withdraw th-, cific Section 5 Hotice, but we were told that were tf-n y served with another notice with a little different termir.yy. which they thought they would have a little better c.nance :c , Our attitude concerning a Section 6 Notice and ccrcerperiodic medical examinations 1 think, could be pretty well co. by a letter that my company wrote to the National Medist'c-r in which we quoted First Division Award 1591, for example, stated that the physical standards which are established ty `:'n company are not negotiable; it is a matter that you can't o<irgj-.* about. I am quoting now from the First Division Award. Possi: Chick, I should ask you to discuss that award before l quote it. Is it all right if I quote the award? MR. HORSLEY: Please do. CHAIRMAN STOCKWELL: Quote: "We think management has the right to reouire their employees to submit to periodic physical examinations. The law reauires the carrier to exercise the highest degree of care in the operation of its trains. How can management fulfill this duty unless they take appropriate ' measures to ascertain that their employees are physically fit to perform their duties?" In Award 13859 the Oivision said: "We find that the institution of a regular periodic physical examination program to assure the continued good health of its employees in the interest of the protection of the public and the equipment handled is a managerial func tion and the same may be unilaterally imposed." The term "unilateral" is used frequently by the brother'".' representatives in discussing our program. Would you elaborate o' that, Mr. Horsley? MR. HORSLEY: First as to the bargainability. The bargainability of subjects is becoming broader and broader all the time. I am afraid that if we refuse to bargain on even the right of management to periodically examine employees, we might find of J.rar'cjn Pa j ] roid% Proceedings of Medical Section '*r a ,dCor 'Nations matter* involving . ne second mediator, which was a rathe? Sro the mood of Locomotive Engineers v; General Chairman as well as by nation:'. :o prevail upon them to withdraw this : tut we were told that we were goinc to ice with a little different terminology would nave a little tetter chance to mcernirtg a Section 6 notice and cones-' tions I thin* could be pretty well c.z->' :any wrote to the National Mediation ; Division Award i591 for example, wh'c : standards which are established oy the -le; it is a matter tnat you can't barga * to te frdtohimsecuathswseardFt?hiarst tawDaivrdisiboenfoArewaIrdq. uoPteosist.i: lease do. Quote: nas the right to require to submit to periodic physical The law requires the carrier to :hest degree of care in the trains. How can management :y unless they take aopropriate rtain that their employees are o perform their duties?" e Division said: institution of a regular examination program to assure realth of its e.moloyees in e protection of the public handled is a managerial funcnay be unilaterally imposed." al" is used frequently by the brol ing our program. Would you elabort st as to the bargainability. The b becoming broader and broader all t we refuse to bargain on even the r Hy examine employees, we might fin ^selves faced with what Mr. Wolfe has discussed, the Section 6 v*.tce and the possibility of running out to the point of self`ip. So in being realistic about it, I think it is a discuss-e subject and it has been reduced to agreement by so many, -'any Vircaos that it is still detataola as to wnecher rt ;s oargain :le or not. The original, pristine sense of mat field 's tnat :t non-bargainable and I think it should nave been held to to oon;:.-aainable all the way through, such as the award tnat Or. Stccx,:!l has just cited to you. There ere two others tnat hold the ,;.:e way and there is no deviation from these awards since that .--e, and those are old ones. But we should be careful in bargain-- on the subject; we'd have to bargain on it, but it must be with :-e area of reasonableness and, of course, with the tenacity of -iding back as much as possible. I am sorry that I can't be helpful on it, but I'm afraid t could be made realistically bargainable even tncugn someone may :iy, as has been said, it is not legally bargainable. CHAIRMAN STOCKWELL: Our legal advisers suggested that we mould discuss this matter but specifically state at the outsat of .he session that we were not bargaining, because if we did bargain ind the mediator then reported to the National Mediation 6oard that agreement could not be reached, they did have the legal right :o strike and might not ce enjoined. Mr. Wolfe, would you comment on that? MR. WOLFE: If you don't mind, I prefer not to use the microphone. 1 don't like microphones. Can all of you hear me in ti.a back? If you can't, just let me know. What they are saying is that if you don't use every means available to settle a dispute when it comes time to seek an injunc tion the unions may claim that the Norris-laGuardia Act applies and you are prohibited from gaining injunctive relief. Therefore, even '.rough you say that this is not bargainable, you'd better go ahead and sit down with them until you get to the point where they strike /Ou, and then you can come into the court and say, "I have clean hands. My hands are clean, and therefore this court of equity can issue an injunction because this is an unlawful strike." If you say, "f am not going to sit down with you at all," then, of course, you make yourself liable to that kind of an argu`ent on the part of the brotherhoods, and I think that's what your people had in mind. While I have the floor, I would for a moment like to address myself to'the first question that you and Mr. Horsley dis cussed, namely, is it necessary for a railroad to periodically examine its train service employees? And in order to answer that 96 Association of American Railroads question, it seems to me you have to examine the objectives railroad company, its goals; wnat are the coals of a railrc*pany?~ quite obviously, to make a orcfit. Railroacs are pr*,*oriented companies, and. therefore, dees it serve ii.at coal periodically examine your train service employees? Tice answer unquestionably yes. That's the first reason. Secondly, it seems to me it is in the public interest, and it is also in the interest of your employees, that your tr: service people be examined periodically. So I don't think any:can argue sensibly the negative cf that question. CHAIRMAN STOCKWEIL: Maybe not sensibly, but they can argue. MR. WOLFE: I wanted the chance to go back to the firs* question. CHAIRMAN STOChwElL: Thank you. 3ecause of the questi-that are raised by these No things that I have mentioned, the sibility of some restrictive legislation or some specific legist tion concerning periodic physical examinations that -ay 5a in National Transportation Safety Act, and this attempt on the par*, the Brotherhood of locomotive Engineers to eliminate cur progra-, contacted a group of railroads. This isn't a complete survey. is possible that we should make a complete survey. 3ut I discov ered some very interesting and discouraging things. I think first I'll comment on what the AAR Medical Section's specific recommendations are concerning a periodic physical examination program, because what I will say folloviing this I think will pretty -well demonstrate hew far we are deviati'or varying from what the recommendations are. We are all fully aware that the Medical Section's recom mendations are recommendations only. There is no necessity for r railroad to follow specifically the recommendations of our Comrr.it* tees and our Section. Sut they are a pretty good guiding rule. u". when one sees very extreme degrees of variation, one wonders why, One wonders whether the periodic physical examination is a neces sity, one wonders whether it is economically feasible. To return to what our recommendations are, I will refer you to "The application of medical standaros by occupational pro file" as recommended by the Committee on Medical Standards and approved by the Committee of Direction of the Medical Section of the AAR on pages IQ and 11, "Instructions to Employing Officers': "Routine periodic medical examinations will be given eir^loyees according to the following occupational classifications: *W' of American Railroad ou nave to sxarrine tee objectives s; wnat ere tne goals ct a 'ai I ruaq : rji<e a profit. Railroads are pro?:.-erefore, Cess it serve that goal train service eroiayees? The answer s tne first reason. s to me it is in the public interest, -est of your employees, that your *r periodically. So 1 don't think anyc :tive of that question. Maybe not sensibly, but they can ed the chance to go back to the firs; : Thank you. 8ecause of the ouestir o things that l have mentioned, the : e legislation or some specific legisla /sical examinations that .may be in :t-ety Act, and this attempt on the part ve engineers to eliminate our program, ads. This isn't a complete survey. ; make a complete survey. Sut I discov* and discouraging things. c nt on what the AAR Medical da ,s are concerning a periodic nii, dbeecmaounsestrwatheathowwfaillr wsaeyafroellodewviniagting .orrendations are. ice that the Medical Section's recomns only. There is no necessity for ar. :lly the recommendations of our Commit* "ey are a pretty good guiding rule, an: r-Pps of variation, one wonders wny. ->c physical examination is a neces>' economically feasible. r recommendations are, I will refer util standards by occupational pro- -T-mee on Medical Standards and - '-"ctfon of the Medical Section of *'.tryctions to Employing Officers": "'>1 examinations will be given ' following occupational * ***, Procesdings cf ''edical Section 97 CLASS A a; Less than 50 years of age--every two years b) Age 50 and less than age 55 --annually c) Are 55 and over--every six no.ntns CLASS 3 a) cess" tha" 50 years of ace--every two years b) Age 50 and less than age 65 --annuaily c) Acs 65 and ever--every six (norths CLASS C cverv two years CLASS~Q Routine periodic meaical examination not required" If this recommendation of the Medical Standards Committee >nd approved by this Medical Section is not proper, chon i tkir.;< it ;rpu1d be changed, and I think we should have some discussion of it. Among the railroads that I contacted concerning their pro gram and whether or not they had working agreements concerning :-ysical examinations, I can mention one of the largest in the est. They have no agreement with any of their brotner,'cods ccn- icrning periodic physical examinations, For tneir loccrctu'e engineers, they examine, for the first time, at age that is, after their pre-emoloyment they are not examined again until they are 44 years old. They are examined again at the age of 50, and tney are examined again at the ace of 55; then they are examined annually from 60 to 54, and from 65 to 69 trey are excmirec semi annually. When they are 70 years old they are examined every three months. Other operating employees working past age 70 are examined semi-annually. This means that the o.niy train service croloyees examined by this railroad are locomotive engineers and in a very restricted way this deviates widely from the recommendations of this Section. The second railroad faced a situation that we are facing now some years ago. There was a strike involved. This is quite a large railroad. As a result of an agreement entered into with the brotherhoods at the time of their strike, periodic physical examina tions were completely eliminated. The employee who is off on account of illness doesn't even have to have a release from nis personal physician when he comes back to work. All he has to dc is book up and say, "I'm going back to work," and he doesn't have an examination by the company doctor. Examinations are permitted when the superintendent consid ers that the employee is unable to do his duty. In other words, the responsibility here is performance of duty as deteimined by a layman. 98 Association of American Railroads Other railroads have tetter agreements. Ore of railroads in the East, for examole, res nareerents their brotherhoods permitting periodic physical e ' - - annua) physical examinations uo to ace 55 for all ; "!> v - service employees. This is a more strict requi reran c (nended by the Section. Examination after 55 :;nti! aca 75 -s .... six months, and after 70, every three months. Another large railroad has an agreement, this periodic physical examinations, out it specifically states - agreement that the employee doesn't h*ve to drop his drc.er-,, other words, he can be examined to the waist only, "nis was entered into some years ago and wrethsr the er.gl.-yeos :s/eby the agreement still object to taking their clothes off ;< don't know, but it raises an interesting question. A large southern railway does have an agreement. All their engineers are required to have an examination v;han they *# the age of 65. Before that they are only examined for vision, color sense and hearing. Suosrvision, however, and the Chief Medical Officer have the right to order mysical examination if there is a question concerning job performance. Another of the larger railroads has no agreement, but they are making periodic physical examinations aoout as reformer.'by the Medical Section of the AAR. In view of this situation, I thought that we should dis cuss very frankly reasons why these periodic physical exoiidraticr-. are worthwhile; and, if not worthwhile, .''y .cot? What should ce done about it, what can Chief Medical Officers that are not per mitted to have a program do about it? 1 have a specific qcescrcfrom one of our members: Supposing our railroad has a rcstr*c:i.-: agreement that will not permit these physical examinations, wnat can I do about it and what can my railroad do about it? Mr. Wolfe, will you answer that question? MR. WOLFE: Yes, sir. The first thing you can do, of course, is serve a Section 6 Notice; the roilroad can serve a Sec tion 6 Notice, to eliminate that restrictive rule. Mow, of ccurcethat means that if the union is unwilling to agree, which they unquestionably will be, you eventually vnll get down the line to the point where you have to put it on the line, and that's what this business that I'm in is all about. You have to put it on tta line, your willingness to take a strike. If you don't have that willingness to take a strike and tenaciously assert it, you mignt as well fold up your tent to start with because the unions will soon find it out and they'll push you to the wall and through it. If you are going to be put against the wall, I suggest this: I think that the rule, the contract rule, which th.se manage ment agreed to is unlawful. I think it is contrary to public ion of American Railroads have better acres,-rents. One of the or example, has aqreemo.n.cs -.-titr. oeve;t:ng periodic physical exenma tipns , :cns jp to age 65 foe ail tneir trai'1 is a more strict necuiremen: than -- . vxam-,nation after 55 until age 70 is , every three months. ilroad has an agreement. This permi*:tions, but it spec!ficaily states in as doesn't have to dreo his drawers; - amired to "he waist only. This aoree-r .rs ago and whether ;he emoloyees cover-- ;ect to taking t.oeir clothes off or np; . an interesting question. railway does have an agreement. All n?d to have an examination when they re al they are only examined for vision, Supervision, however, and the Chief right to order physical examination if ruing jot) performance. arger railroads has no agreement, but ;nytical examinations about as recommence: '.ne AAR. .i ion, I thought that we should dis .fcese periodic physical examination; t -crthwhile, wny not? What should be '>:* Medical Officers that are not pern doout it? I have a specific question .-.tosing our railroad has a restrictive '-it these physical examinations, what m ry railroad do about it? insthat question? . The first thing you can do, of ''-.`.ice; the railroad can serve a S? `it restrictive rule. Now, of cour billing to agree, which they will get down the line tc ! 't on the line, and about. You have to that's what put it on t --r'ie. if you don't have that t' iciously assert it, you migh " :th because the unions will ' r.j to the wall and through it *:ifnst the wall, I suggest rtrjct rule, which that mana 1 >t >s contrary to public Proceedings of "edical Section 99 ;,cy, it's against the public interest, because it permits people ' j unquestionably are physically unqualified to operate trains ; ;o work in and around trains. This affects tne public as well .> tne private interest, and therefore l wcuid s'-vciy refuse to 'cree the rule. 7 ..cu'.d violate it, and than 7 would put tha . .r-js on the union to do something about it; ana *nsn they ---Taten to strike you, I would tnen go into court to enjoin applition of the rule on tne grounds that it is unlawful. That's a second remedy wnich you may consider. CHAIRMAN STOCXWELL: Mr. Horsley, will you comment on this, :>rticularly on Mr. Wolfe's suggestion, from tne point cf view of ;' railroad member of Division 1, Railroad Adjustment Board. MR. HORSLEY: At the outset we have the action of the 'irst Division with respect to the decisions called Awards tnat Dr. :::cKwell has sooken of. Those are m.emoriaii2ed in the recoro as c.ording the fact that the carrier has the unilateral riche; and I ;ink, as Mr. Wolfe said, that that unilateral right of the carrier '.o examine is consistent with public policy so tnat in view of our character as insurers of safety, that unilateral right is further supported. And any rule that flies in the face of or flouts the ;-jfety of property and persons is contrary tc public policy. And I ugree, not because we are in the same business, but I agree with :re logic, and the legal logic, of the statement made by Mr. Wolfe. MR. WOLFE: There will be those who will disagree with me. Cut you stick with it for it will get you in the courthouse door and you very well may win. CHAIRMAN STOCKWELL: Or. Wight of the Canadian Pacific. OR. E. EARLE WIGHT, Canadian Pacific: I'd like to ask a theoretical question. Unions are "he same for all railroads, but they make different agreements with different railroads. Supposing Railway A does not subscribe to medical examinations, like tne one you mentioned. Railway B follows the reccmmencacions of this asso ciation. Very often it happens that trains from Railway A run over trackage of Railway 8, or there is interchange or something else, khy couldn't Railway 3 say, 'No, no, we can't let your trains run over our lines. We don't think your men are qualified. Your engineer might die and tie uo our trackage and cause a wreck or something like that"? Couldn't there be some little thing like that? CHAIRMAN STOCKWELL: Your question is a good one. This has occurred, and I can't give you a specific example but it has occurred. DR. PAUL PRETTER, Union Railroad: First of all. I'd like to congratulate Mr. Wolfe. In my three-and-a-half years working for a railroad, he is one of the few members of management I have TOO Association of African Railroads ever hoard with- guts enough to get off the fence and say sere:* of value--rather tr.an refer it to the Medical Decartrent. 3u: ; have a question: Why do we Unit this to train service emolcyeos? jo other members of railroads' wor* -'oroe sue 'ess? Do trey "?v; ; other reason viiiy we shouldn't ev.oriro -.her periodically? ?o r.--. have less sicknesses or cause less of a problem for the railrsa;- CHAIRMAN STCCKwELL: I think your question is a good MR. HORSLEY: I'd like to take a swing at it, Or. S*oc.<well, when you have finished. CHAIRMAN STCCKWELL: I think it would be very desiraoie examine all of toe employees, of**'" them the privileges of a osriodic physical survey. That would be very good preventive medic:'. OR. PRETTEk: I nay add that on our railroad until recently no one ever had an eye examination after the pre-employexam. They could coma co work and work for 35 years and be bl':nc, and I found them blind, and be deaf, and I found them deaf. The interesting thing is. management will always turn around and say, "Well, that1: a medical problem." You're suppose: to find them when you don't see them. My feelings really are that most of the ills that go on -the railroads are because management nas been blind themselves, ic not looking forward enougn and anticipating some of the orcblems. They have not tried to do anything about hearing conservation, about eyesight, about periodic exams. I think perhaps mis Medics Section should do something to further this purpose. I have discussed this sort of individually with some of the members here, and the feeling I get is that many departments o* the AAR and the individual railroads are not interested in tnis because it doesn't further their own cood--and I particularly toe:of the Claims Section. I have the feeling that many cf then interested in changing anything or improving the situation in the railroads, because they feel this might be a threat to their own good. I am speaking from my own personal experiences. CHAIRMAN STOCKWEIL: After .Mr. Horsley rakes a comment, -f will ask Mr. Risendal to comrnent from the claims aspect. MR. HORSLEY: The doctor his ;eferred to other than ontrain employees. Let's just call them off-train or non-operating employees. The subject hasn't been as rife with the non-opera:'::-: employees. However, there is a jurisprudence, if you could digr'Y;the other divisions of the National Railroad Adjustment 3oard witn that term. The Second Division has to do with shop men for of ^ri;.'.n -iiiiroacs :o get off the fence and say sorett--U to ti.e Medical Department. 2u: ; is to train service employees? Do *orx force sue less? Oo *hsy have 't examine them oeriodicai;y? Do se less of a orcolem for t,-,e railrca::' : I think your question is a good one. like to take a swing at it, Dr. $toc.<j. : I think it would be very desirable offer them the privileges of a per. : would be very good preventive medic-. / add that on our railroad until eye examination after the ore-emolov >rk and work for 35 years and be biir.: be deaf, and I found them deaf. ing is, management will always turn s a radical problem." fpu're suppose*, see them. a lat most of the ills that go on ' :na5 ...ent has been blind themselves, :nd anticipating some of the problems, ytning about hearing conservation. Me exams. I think perhaps this Medic:; to further this purpose. Ms sort of individually with some of eling I get is that many departments ailroads are not interested in this neir own good--and I particularly see-' ve the feeling that many cf them are m ng or improving `.he situation in the this might be a threat to their own cv<n personal experiences. After Mr. Horsley makes a comment, ent from the claims aspect. octor has referred to other than oncall them off-train cr nen-operatinq 't been as rife with the non-operat;"` c a jurisprudence, if you could digrMT iticnal Railroad Adjustment 3oard with ;cn has to do with shop men for Proceedings of `helical Section ! 01 classification; the Third Division has to do with clerical crafts ind telegrapners. The Second Division recognizes that the carrier has a right to require physical examinations, ana tr.en they have a quali fication "in proper cases." There is an instance, for example -r.iy of a dining car waiter whose condition hao to go ail the wav a syphilolcgist to -esolve the quest'd'1, ana [ think it nad to to with the validity of various tests that were used to determine .-is condition. And ail of the Second Division cases have cone only to individual or ad hoc situations, r.qt tne general question as to whether tne blanket periodic pr.ysicai examination may be installed. On the Third Oivision, it recognizes that the carrier must take precautionary measures to determine tne ohysicai fitness of employees, and the Fourth Division likewise. 3ut the First Divi sion has to do with the on-train employees; and it is not, Doctor, that the otner Divisions sue less or are less of a threat, but l tmink it is properly divided on tne basis of the service chat they perform and the importance to the oubn'c of the service that the crafts perform in the different Divisions. MR. WOLFE: Or. Stockwell, may I cut in here a minute? CHAIRMAN STOCKWELL: Certainly, at any time. MR. WOLFE: I think that question was really addressed at railroad managements, and since I represent railroad management in i fashion, at least I'm of them, I'd like to answer that. In my own personal view, and I think it probably represents the view cf -y company, we definitely should have a complete program, a program of qualifications, a program of standards-of spec:ficaticns, if you will--for each job, and how often the person occupying chan job should be examined, and the physical qualifications or disqualifica tions as a result of the examination. That is something I don't think we have. [ don't know how many do have it, but I nope we will have it soon. CHAIRMAN STOCKWELL: John, could you make any comment con cerning the attitude of the Claims Oivision? MR. RISENOAL: Yes, sir. I think that no one, other than perhaps the doctors, within the railway companies has a greater 'nterest and concern in the adoption and insistence uoon high ohysi cai standards for all employees than do memosrs of railroad Claim -foartments. They know full well wnat happens when people with jftferior physical standards are accepted into railroad service. 'hey know from day-to-day experience how many physical conditions nlctt are completely unrelated to any occurrence on the railroad They wind up paying for, either because there is no real program of R^-employment and periodic physical examinations whicn would weed cut the physically undesirable, or oacause exceptions are made in 102 Association of American Railroads cases which permit acceptance of those people who do not reo: standards wnicn may have been prescribed. There is plenty of work for a railroad claims ~an m handling the justifiable claims which arise from or-duty -c:--;.i to employees; and they are will-.ng, ana must, nandle tress on their merits. But they are sick and tired or paying for ccrci-. for which the railroad is not and was net responsible. So I can say perhaps the views of Claims Deocrtr.er.t sentatives have not been listened to as they snculd be. railroad claims men are not as persuasive, in seme cases, as r should be, but they all recognize the .need for the adoption an; implementation of high physical standards. { CHAIRMAN STOCKWELL: Thank you, John. I In order to demonstrate even further why it is necsss-v J j and essential that we have periodic pnysicai examination rrec:;- I plan to quote at some length from an address that was given i Mr. Owen Clark, then Commissioner of the Interstate Cc.-vercs C:~ i mission, to this group onMarch 23, 1957, at a very fine meting the Section that was held at White Sulphur Springs, Lest Virgin-. I recommend his speech in its entirety to ail cf you, anc it ,>o. be of particular value to you in discussing the necessity for -.-i program with your management if you are having problems. I will only give his last statement in his speech. Quote: "At the very least, however, gentlemen, your i recommended standards should apply uniformly throughout the railroad industry as an abso i lute minimum." We have already discussed the Question that v/as asked several men in the group, and that is, dees the railroad have :' = * right to periodically examine its train service employees; and : there are any questions from anyone in the group as to wnetner c* not we have the r^ght, I wish you would say so now. %i ii OR. ARTHUR J. SUTHERLAND, LIN: I had an experience re*-last August and September when we took over a section of t:.e or: t and we offered jobs to 67 of them, these men chat were working; . < 42 of them out of the 67 were able to pass. So it demonstrates . necessity or the feasibility of periodic exams. t CHAIRMAN STOCKWELL: Dr. Kaplan. OR. ISADORE KAPLAN: I would like to address this to '*r Wolfe, please, because in the spring of 1967 we had an actuai s" tion present itself at the Huntington car shop. I am certain j-- i< i are familiar with it, in that we actually had a strike as a res-..- of a physical examination requirement. One of the car men, a sky diver, had been on one of his air circus shows the Sunoas ` it', on Of -reric3fi Rai 1 reads ceptance of those people w'ro do not "eat .ve zeeo proscribed. ty of work for a rai^cad claims -ran in :le cial^s which arise *'rpn on-duty acc:dvv are willing, ana rust, nanole tnose :r / are sick and tinea of oo>;ng for core;-. : is not and was net responsible. pemaos the views of Claims Department re-an listened to as they should be. Pern-.:e not as persuasive, in so.ro cases, as 1 recognize the need for the adoption arc pnysical standards. cwEll: Thank you, Cohn. e-or.strate even further wny it is necessar, nave periodic physical examination progr?~. v length from an address that was given by urr'issiorier of the interstate Commerce Co~cn March 28, 1957, at a very fine meetinr . it Id at white Sulphur Springs, West Virgin-;, in its entirety to all of you, and it wen/-, to you in discussing the necessity for the :e-.-nt if you are having proolems. I will tv t in his speech. Quote: aht, however, gentlemen, your '..jndards should apply uniformly - railroad industry as an abso- i discussed the question that was asked 0/ mi that is, does the railroad have tre -..wine its train service emoloyees; and if . anyone in the group as to whether or \ wish you would say so now. '..''5lASO, LAN: I had an experience here^ *r xe took over a section of the old ' .* them, these men that were working; c' "-e able to pass. So it demonstrates V' of periodic exams. Dr. <aplan. ' '>* would like to address this to Mr. * '.prmg of 1987 we had an actual sit- .vrgtcn car shop. 1 a/n certain you -- .-ctually had a strike as a resui'- .iro^nt. One of the car men, who *'* M< sir circus shows the Sunday Proceedings of Medical Section 103 -feeding the date he was supposed to go to work. His parachute ';r.ed too close to the ground. As a result, ne sustained rather '.'rious injuries to the lower extremities, back ana shoulders, end i pare to work on crutches. Management refused to pc.-rmit rim to s to work. He was referred to the iocal surgeon, -,,no also 'efu ; permit him to go to work, and, as a 'esuit, a strike was called. ; lasted about one v.-eek. The entire shoos at Raze'and, .-.niph .-ploy about 2CC0 employees and laborers, went out i.n a sympathy -trike, and, as a result, all operations in the r.untington-Aacaiana :rea practically scooped. The management, of course, maintained that they had the right to request a special examination and, oas-cb coon disability, e<t he should be disqualified. The labor organization countereo V saying it nad a contract with management, wnereoy the only time i car man was suoposea to be examined was at ti --0 or` original `-oloyment, and thereafter he is not required to submit to examin ation. Can you now enlighten the group as to what finally was resolved in that problem? MR. WIFE: I really don't know the final resolution of it, Doctor. I lost track of it after we got the people back to ork. At that time I was with the National Railway Labor Confer ence. That was before l joined the ,\'orth Wes tern; and your C&Q lawyers got in touch with me, and I discussed what legal action they should take to get the men back to work. And, cf course, it presented a classic case: It was a minor dispute, that is, a dis pute over what your existing rules are; therefore the strike should have been enjoined immediately. And I think they tried Out they had some difficulty, time-wise, getting to the rignt judge, as 1 recall it. How it eventually came out I really don't know. After they went back to work 1 lost track of it. That was an interesting case. CHAIRMAN STOCKVIELl: Thank you, gentlemen. At this time I tnink we will leave the labor relations asoects of this problem, temporarily. There are many more questions I want to ask of our panelists, and I'm sure seme of you do, too. Sue at this time we'd like to get into the physical examination itself, and l think the first obvious question is, what constitutes a good periodic physi cal examination? I think we will ask Or. Hinchaw to tell us a little bit about this now. DR. HINSHAW: Thank you for the opportunity of being here, "ost of us are doctors and I would like to discuss some of these prcolems from the standpoint of the treating physician. The ques tion of preventive medicine has arisen here on several occasions. 104 Association of American Railroads 1 should like to think that if this were the best of ail -.or'-.- we could develop a relationship petween the doctor ird the be he "company doctor" or 'personal physician"; a a productive, so compassionate, so efficient, that the pave.'t seek to have examinations carried out at his own instica;;::; consider this a privilege, not a requirement. I should like to think that the doctor is not enctco-i what you might call "medical espionage" or e>/en medical f.irve-. 1lance, but he is there to detect ailments which are in a ceverc; stage, which might be prevented. I would l''ke to think that tv ; employee wants to be examined in the hope of lengthening vis in the hope of improving his earning capacity, in the none of br a happier and better person. It is true, of course, that there is a conflict cf inter est occasionally, but I'm not so sure that conflict of interest between what is best for the patient and what is best for the ccr pany should arise as frequently as it appears to arise. In other words, in most of these circumstances what is best for the ccmpio what is best for the public, is also best for the individual. Ideally, in this best of all worlds, the company doctor, if you want to call him that, also would be the personal physic:^ to that particular patient, v.'hen he or members of his family develop symptoms or desire medical consultation they should go first to this physician, as a personal physician who is in toe pc-: position to determine whether or not the e.roloyee is ccc,>oie of carrying on his work, whether or not he should continue to do so. The average employee resents what I called a moment ago "medical espionage," but he doesn't resent examinations when ha c-r. be convinced that the examinations are for his own welfare end for the protection of his own future earning capacity. I knew tnat this sounds idealistic, but I think it can be attained; and in our system at Southern Pacific it usually is attained. A large share of the employees choose to come to cur hospital, having seven: the advice of our on-line physicians, when they are ill. We have a relationship with these patients which puts us in 3n ideal position to know when any man should be restricted in his activic:es or when he should be disqualified. Vihen we do run into a conflict of interest, if we are true physicians, I think we should frankly admit it to the patient and say, ,rI can understand why you would like to continue to work and support your family in this particular position, but as company doctor I have to advise you otherwise." In other words, if we can frankly admit our conflict of interest to the patient, we can retain that doctor-patient relaticnshio whicn is so valuable, Tut this Is best attained when doctors care for patients over a period of years. A well designed, all inclusive medical care plan, well organized and well executed, facilitates the growth of a orooer dottor-patient relationship. The time may come v/hen the erp'ovsr con siders his employees much as he considers his mechanical equipment. .`.-erican Railroads if ;ri$ were the best of all worlds, .no between the coctcr end the cat-.- ; ^regnal pnysician"; 2 re1 at:onsmo : so efficient, tnat the patient ,,c.. .med out at his own instigation anp pt a requirement. mi that the doctor is not encaged .coionage'1 or even -ecical surveil. .tec aiirents wnicn are in a cevelc;-- I would lisie to think that :r~ ,-d tn the hope of lengthening m's li-.-;, t earning capacity, in the hope of ce-.- me, that there is a conflict of inte-oi so sure that conflict of interest ? patient and what is best for the c;.-itly as it appears to arise. In other --.urstances what is Pest for the corcpar. is also best for the individual. .<jst of all worlds, the comoany doctor, also would be the personal physicie.*. -ren he or members of his family - al consultation they should go o .crsonal physician who is in the tec: vr or not the employee is capable of **r or not he should continue to do so. re resents what I called a moment ago i'.'rsn't resent examinations when ne "Jt'.pns are for his own welfare and for earning capacity. I knew that * . '.rink it can be attained; and in cj' 1 usually is attained. A large share to our hospital, having sought t"2 when they are ill. We have a wnich puts us in an ideal posit:: i restricted in hi $ activities or w.r-r conflict of interest, if we are tr.s i rrankly admit it to the patient and r J -sold like to continue to work anc ^-titular position, but as comoany >'[ In other words, if we ca' /"erest to the oatient, we can '-! trship which is so valuable. 8-' care for patients over a peri:: 1 \ J'clusive medical care plan, well Ii ,!^tes the growth of a proper come when the employer c:'` * considers his mechanical equipmed Proceedings of `'edical Section 'C5 're nan is an asset to the organization, he is earning money eor ;5 comoany, he is a "machine'' that has to be serviced occasionally, o is a nacnine that has to be repaired occasionally and eventually eolaced; and if the servicing, "pairing and retirement wore cant - the same program, many of these conflicts shouldn't arise, out --gy do arise, even in this Pest of all worlds. -ent? CHAIRMAN STCCKWELL: Or. Strange, would you like to com- OR. VANCE STRANGE, Southern Pacific: I think under our :rogram that we are in a constant screening process for our employ ees. We do have good relationships both with our membe^snio and mo our employees as a group. If this continues, and if we improve the type of oeoole we have, people like Or. Hinshaw, I tnink we can offer service to both tne company and the employees. We have been interested in health inventories and Or. -wnshaw has been in charge of that program. We were in nooes t.nat , might be able to start a health inventory plan along with cer:in laboratory work, on-line. This could be carried but on a .ear's basis for all employees. We have run into difficulties; I -ill say that most of the difficulty so far is educating cur own doctors on-line that this is a good program. The way we are attempting to do it now is to have the taople admitted into our hospital from on-line, pre-admitted with the health inventory coming in with it. Now, the health inventories that we used in our own office cowntown, subject to the railroad. United States Steel inanaoement caoole, worked out extremely well; cut down on doctors' time, and I '..link they will have statistics some day that will be of great alue. I just hope we can say the same thing for our approach. CHAIRMAN STOCKWELL: Thank you. In connection with the 'tlationship between the examining physician and the employee, I think it's most important that he be assured that this is a confiential relationship, that this medical record that is sent back co ::me place in the railroad is a confidential document. Medical privilege is respected, in my opinion, and should be retained in -a Medical Department and not be available to management and labor :r any other inauiring individual, without first obtaining the spe cific authorization of the employee to divulge that information. Dr. Hinshaw, would you like to comment on that phase of it ` little more? DR. HINSHAW: I don't think that is impractical, and, `"deed, if you are to have a proper doctor-patient relationship, clinical data must be confidential. I can't remember any important -'rcumstance when a patient has refused to let us divulge the ^sults of a medical examination. Usually the patient who nas an fluent, of whatever nature, is perfectly willing to have it 1 i 4 I t j 1 i j --- 106 Association of American Railro'-ds divulged in order to have it corrected and treated, tha 3 are other patient. The nature of these examinations oc-serves f.comment, I think. Or. Strange mentioned the "health i/v/s-i-ory" whicn essence, a medical nisccry, a 3elr-?recorec medical Lister.-, series of Questions, aoout 200 in number, not uniike the r'-l. Medical Index, with s^nich some of you may be familiar and ,, been tested very wiaely over the country. This series of :.informs the physician -bout the neal tn experiences, tre nei. hazards and the medical ana sociai background of the indivic.. what amounts to an excellent medical history. Later on this morning I see we shall have a discuss the subject of multiphasic screening programs for the detect'-disease, so I shan't go into that ncrw because I am sure Mr. I- will be giving us the details of this system of examination. But a thorough medical history, a physical exaninat-.r. and a series of laboratory tests and X rays can tell us a gre* deal about potentially disabling illnesses, some of wnicn are capable of being remedied, many of which are not known to tr.e patient, many of which would not have been revealed to che oar but for such a comprehensive examination. Who should be exam: how expensive it snould be, how practical it is to apply on ? versal basis, is another topic that we can't settle here. But ; should like to think that preventive medicine is tied to curar medicine. I should like to think that employees can be encour: to regard periodic physical examinations as a privilege and nc: a necessity, that they may seek this and ask for it in negotiar their contracts with management. CHAIRMAN STOCKWELL: Mr. Wolfe. MR. WOLFE: I am going to get into this doctor discus;for a minute. Your inventory program. Dr. Strange, is a very interesting one. I would hope that you continue that. It sour., to me as if it has many possibilities. As an outsider looking in, as a labor relations office' who occasionally giances at tnese files as they come in from me-bers of my staff, I throw out to you to think about because I c;' purport or assume to have the answer--but it does seem to .me tc present a problem where you have the personal physician of a *;" who is one of your local doctors examining an employee for quai' cation purposes. Human nature being what it is, I chink it is impossible, in most cases, when it comes down to the basic fact whether that guy is going to be permitted to earn his living, fc that doctor to say, "You are disqualified." We have had cases where our Medical Department in Chi ca bas had to overrule our local physicians for that very reason, s' - - ,,no r j:rt and, - OitiO.V i -ICC 1 : c n - -if r n re to -vrrec : '- ! <e i '^ clinic 3an Fr it Iccai 'Meal q ew :.n of American Pailreads it corrected ard treated, the sar-.e c of tnese examinations deserves fur:.-.' .r.r.ed the "health inventory" ,-inicn is. a sel f-prepared medical history, ; . K\} in nur.oer, not unlike tr.e Cor^e.' sore of you may be familiar and wn ip,-. ,-r the country. This series of auasv. the healtn excenen ces, tie health vi social background of the indivi gUQl , .(it medical history. rni.ng I see we shall have a discussion . : screening programs for the detection . r to that now because I am sure Mr. Sm;:jiH of this system of examination. -oical history, a physical examination, / tests and X rays can tell us a great tooling illnesses, some of v.-'nich arc , many of which are not known to the ,id not have been revealed to the pati=r ve examination. Who should he examine: hew practical it is to apply on a or: ' '* that we can't settle here. 3ut l ntive medicine is tied to curative to ,,,:ink that employees can be encouraca. :l examinations as a privilege and not seek this and ask for it in negotiator : .hr. Wolfe. -.deg to get into this doctor discussio' ' ri program, Or. Strange, is a very ..o that you continue chat. It sounds 1 i ties. in, as a labor relations officer files as they come in from mem- ' to you to think about because I cct.' - it does seem to me to * - the personal physician of a ran 'camming an employee for quaii'"' '-I'-g wiiat it is, I think it is 't tores down to the basic fact :-rr" tte-d to earn his living, for ual ified." ~ ',r "edical Department in CM cage for that vary reason, i:- Proceedings of Medical Section 107 it presents a difficult situation when that happens, difficult for our people in Chicago and difficult for the local men. We had a recent case; in a recent heart attack case our file indicates that two local company doctors on one distr'et actually decided that our Medical Ceoartnent in Chicago was wrong and furnished the employee with statements in support of his conten tion that he was qualified. Now, I am sure Dr. Stack and Dr. Soeer probably no longer j$e those lads who did that. But this is a case wnere our local doctors, because they were the personal physicians of the men, actually turned on us. This seems to present a problem to me, and I say, I don't know what the answer is. Perhaps you can come up with it. OR. HINSHAW: May I ask for a moment to say that in our own system we have what might be considered as a suoreme court in .cat the local treating, on-line physician is not necessarily the one wno makes the final decision as to disqualification or restric tion. He obviously sees the situation from the patient's stand;oint and, indeed, as I said in the beginning, in most circumstances the patient's best interest is also the company's best interest, jr.d vice versa, out there must be a supreme court, a final agency of unimoeachable quality, an agency which has the medical experience and facility and know-how to obtain documentary proof of disqualifi cation when that can be obtained, and usually it can be obtained, so that the on-line doctor does not make the final decision neces sarily. CHAIRMAN STOCKWELL: Dr. Strange, and then Dr. Stack. OR. STRANGE: The on-line doctor we give no responsibility to in returning people to duty in problem cases; they are all Inferred to me. We have letters on them. We have reports on them. Then we will bring that man in from on-line and he will go through :-he clinic examination that we have afforded him. The final deci sion is made in San Francisco. No "injury on duty" case can be put back to work by a local physician; he can only be put back by the attending pnysician in San Francisco. It makes a lot of trips back to the city but we tnink it is well worthwhile. Never leave that responsibility to local physician. DR. HINSHAW: It requires a rather complex grouo type of fcdical organization, from the clinical standpoint, too, doesn't it? nave. CHAIRMAN STOCKWELL: Which, I may say, many of us do not Or. Stack. 108 Association of American .Railroads OR. JAMES STACK (CSNW): e ooerate in nine states, have about 500 doctors. All of them are on a feo-fpr-servi basis, and al1 of my professional life i have been /earing re hats but t.hree--as a teacher and a chief surcecn and a oract'tioner. And an awful let of these people wording on our ra;>are graduates of our school; l ''iv hod them in ciass. This : very important thing, to have this kind of a relcticnsruo; iro when this subject comes up, and let's say trat there is sore ous disagreement, I can pick up the telephone and say, "New, what in the hell did you do this for? You know better than to*:. But the thing that we try to do is orotect these men because the doctor in many instances is in the town of, let's Escanaba, Michigan, or Pierre, South Dakota, or Long Pine, Neb/-, and he is our doctor and he is the patient's doctor, and we mu;; protect the doctor and we must get him off the hock, so that he can go to the patient and say, "Now, look, John, 1 -./ant you to ;; back to work, I think you can go back to work, but that son of a gun in Chicago is the one that's keeping you from work." I think this is a healthful way of solving the problem you brought up. CHAIRMAN STOCKWELL: Gentlemen, we will continue this discussion, because there are several who would like to be naarc, after a 10-minute break. (Recess from 10:30 to 10:40 a.m.) CHAIRMAN STCCKWcLL: Gentlemen, we will continue; and lr. connection with examining locomotive engineers, I will start this part of the session by reading a quote from The Detroit News of February 12, 1969: "Melbourne, Australia. The engineer of the Southern Aurora Interstate Express was dead before hurled into a train Friday, killing nine persons. . . . They said a post-mortem shewed that Engineer John Boden, age 50, suffered a heart attack before *ne 80-mile-an-hour crash near '8i1a` Town 160 miles from here." The next question that I think we'll get into is a matte of how to handle the individual that is examined as a result cf : periodic program and who is found to h3ve an impairment that wcui make it unsafe for him to be continued in service. The question is: Should there be a standard operating o cedure developed on the railroad for the handling of the disquai' fication? How should the employee be handled who is found to hav a defect which requires disqualification, either temporary or permanent? jn cf American Railroads Proceedings of Medical Section 109 (C.'v'iw): We ooerate in nine states. ,.... Ail of tnem are on a fee-fcr-service '..s:cnal life ! nave been wearing not . vr >nd a chief surgeon ana a oracti -f these peoole working on our railro-; :!; 1 hove had then in class. This is -jve chis kind of a relationship; anc .0, -jr-d let's say tnat there is so,re so-,'t -,o tne telephone and say, "Now, Jcj, :o mis for? You know better than this. s .o try to do is protect these men / instances is in the town of, let's sa, rrr, South Dakota, or Long Pine, Nebrt;. n is the patient's doctor, and we rust r*;st get him off the hook, so that he i/, "Now, look, John, I want you to so . can go back to work, but that son of * t.'at's keeping you from work." t healthful way of solving the problem .1: Gentlemen, we will continue this sr* *m several who would like to be heard. tv - 10:40 a.m.) . 'lentlemen, we will continue; and in 'c-ccrotive engineers, I will start this a quote from The Detroit News of The engineer of the Southern f :j;ress was dead before hurled *, tilling nine persons. . . . snowed that Engineer John .'i-r+t & heart attack before the rear '8ila' Town 160 miles '*. ! think we'll get into is a matter c.vl sr.at is examined as a result of our ' .* i to have an impairment that would * ^nufrued in service. ere be a standard operating ore *T 1* ** e the handling handled who of is the disqualifound to have t'.on, either temporary or i I think several individuals here may wane to discuss this ."d I think it is very important. I think it is important for this on, that if >t is improperly handled you're going to have a jr.cred percent objection. If it is properly handled l thins many .* tne objections can oe avoided. Specifically, how should this individual be notified that e isn't physically fit to be continued on the joo? The one thing that we want to avoid is for him to receive the impression that he is fired. So often tnat is the case. They ;n a short message from their immediate supervisor, "vou're -.-.rough, Joe. Turn in your eouipment,'' period, it does happen, .antierr,en, and it snouldn't happen. Or. Hinshaw, would you make a comment on this? DR. HINSHAW: Yes, I'd like to comment on that because I believe that one of the principal jobs of every attending physi cian, under every circumstance, whether it ce industrial or otnerwise--one of his principal jobs is wnat might be regarded as salesmanship." He has to sell his diagnosis to the patient. In the first place, he has to have unimpeachable evidence, e has to prove to his own satisfaction first and then to the patient's satisfaction that he has a correct and precise diagnosis. He must be able to sell the patient that idea, and : would feel very strongly that it is the doctor's duty to sit down with Joe and tell Joe exactly what he has, explain to him tne mechanism of it, explain to him what might happen if he did not accept the a f i nn . I spoke of "unimpeachable evidence." Take coronary artery heart disease, for example. Too often in the past we have been forced to rely upon symptoms, upon wnat the patient tells us, upon his testimony as to wnat his sensations were under certain condi tions of exercise. But as time goes on it becomes more and more possible to put this on an objective basis, and as seme of you may know, within the last few months Or. Strange has arranged to have installed the full facilities for coronary arteriography to deal with these problems. Take the case of a locomotive engineer wno seeks an examination because of symptomatic or electrocardiographic evidence of coronary heart disease. If he can be subjected to coronary arteriography it will be easier to tell him, "You mustn't run a train any more because you might collapse at the throttle, and you will be the first one to be killed in the event of a colli sion." So 1 think it is the doctor's job to explain in full detail the reason for and nature of medical impairment. The doctor has to be compassionate, in his approach to the problem, but nonethe less firm, and he must have the evidence, he must have the support no Association of African Railroads of convincing medical authority and the very best eou'prent facilities. CHAIRMAN STOCKVlELL: Thank you. Doctor. My specific recommendation is that an established be arranged, handled in the pare way in all cases. Specifics/., on our railroad cur periodic examinations are .Tads on a race." by a physician wno travels around frcn yard to yard, and he no action if he finds a man that ha tninks is pnysically unfit simply sends his report to our office. At that point we contact the supervisor, generally tfa superintendent, and advise him that this man has a pnysical cc.-.tion that mignt interfere with the safe performance of his dues-, and that he should be further medically examined--?;/ his oersena; physician, or, if he chooses, he can cone to the Detroit Clinic (and with some emohasis on coming to Detroit if he will do sc}. Then we will have the opportunity of talking with him, and many times it is most helpful, with his wife, and explain to them, ?.s Hinshaw has suggested, the necessity for taking some type of acv/ that is going to result in reduced income for him for a oer'cc. I suggest that some established procedure is of value. '* Wolfe, would you like to comment on this? MR, WOLFE: I personally feel that an established crccacis almost necessary. There are many people in the field, however, who disagree with me. I askad six of my staff officers to give -? their views on this auastion, and all six of them said boat c.ney thought we should have no established procedure but handle it case by case. So you aren't going to find the labor relations people " agreement. I feel, however, that it is desirable. I feel that eventually it probably will come to be, and I expect it to come tc be on the North Western. CHAIRMAN STOCXWELL: Mr. Horsley. MR. HORSLEY: Just very briefly, I don't believe I dia metrically disagree, but I would like to say this, that in the experiences I have had, the lay exoeriences that I have had, this 1$ the greatest area for, you will pardon the expression, that bedsida manner that I have heard about since a child. This is the area of contact between the doctor and the man wno has this condition. So that if there is any diagrammed procedure, I certainly urge that i* be this confrontation between the doctor and the patient himself, and this bedside manner be emoloyed, if I may say so, because of this reason. And I will conclude in a second, that when tr.e train master tells this man that he has a physical condition that necessi tates his being removed, you don't know what else that train master will say; and I know of several instances of what else he has said, that "We haven't been able to get you up to now, but by God we got you now and you can't work any longer/1 And that is what happens of /.merican Railro.-idc thon'ty and the very Pest equipment .ELL: Thank you, Doctor. r-r?ndation is that an established or::< same way in ail cases. Sceci f-i'. = -' .qic examinations are made on a caqic;. around from yard to yard, and he *n shat ha thinks is physically unfit our office. contact the suoe*-visor, generally the i him that this man ras a physical cc : -itn the safe performance of his dut;c.c'ler medically examined--by his person-; '.cs, he can ccme to the Detroit Ciin-q . coming to Detroit if he will do so). :-rcunity of talking with him, and many with his wife, and explain to them, as - necessity for taking some type of act;- reduced income for him for a period. *x? established procedure is of value. ? cmnent on this? tonally feel that an established prof . are many oeoole in the field, howevs ix of my staff officers to give ..n d all six of them said that the;. 'taPlished procedure but handle it zz no to find the labor relations people , that it is desirable. 1 feel that cone to be, and I expect it to come : Mr. Horsley. very briefly, I don't believe I diauuid like to say this, that in the 'ay experiences that I have had, thi >'! pardon the expression, that beds >t since a child. This is the area f tfc man who has this condition. *d procedure, I certainly urge that tr.a doctor and the patient himself cloyed, if I rray say so, because of '-c* in a second, that when the tra '-c a physical condition that nece: know what else that train masi '^stances of what else he has sai Sit you up to now, but by God we gc / logger." And that is what happens Proceedings of Medical Section m .. ..jut should be the bedside manner--and again 1 apologise for *. :erm, as such--it's the only one I <rcw--cut, as a substitute it, there isn't any. So that wo get into a lot of trcuole by .. confrontation between the employer and the f-oicyee, ratner ,n petween nis loving doctor and nimseif. One more second: When cne railroad put nut an arnounce-t, of periodic cnysical examinations, tnere was no prooiem with put when they took them by ace groups they said in a letter, Jonnson, because you have now re-ac.ned 65 years of age, it will - i-perative that you go to Doctor So-arc-So, :r. p- tefore toe of next month," and the fellcv/ doesn't want nis ace actually -'erred to. These are the little areas of tact and diplomacy that are ;.sing and should be employed. If it is diagrammed it should be - something like that, other than letting the employer tail him .-etning, because he'll tell him more. Thank you. Dr. Stockwell. CHAIRMAN STOCKWELL: we have a specific question from the .>dience, which is this: Goes it make any difference in the han ging of a disqualified emoloyee if the railroad Goes or does not ->ve the provision in their working agreement with the brotherhood ::ncerning re-examination of a disqualified employee? Mr. Horsley. MR. HORSLEY: Unfortunately, it does not make anv Mfference, according to the decisions from the courts on this :tint, and l won't give you any cr.aoter ano verse. But it has corns ;cout in this fashion, that tnere is a dispute abcut tne pnysical ;ondition, and wnen it comes to a tribunal and this is a lay admin istrative tribunal and the referee or the neutral is looking for an hut or basis upon which to make his decision, he adopts this threedoctor panel as a nostrum by which he can decide or reach a deci sion as to what should be done. Now, that has been approved by the courts on the basis '.hat the tribunal, the arbitration tribunal to which this dispute tomes, has the right, because it cannot cecide the meoical question, 'j seek the aid of medical advice; and tnere is a dispute between t'o medical men concerning this man's condition, so we must draw in i third--and that has been characterized as being the rignt of a deciding tribunal to the aid of your profession in reaching a con clusion. But let me say in one more second, this: that there is no right, gentlemen, to a medical panel, witn or without rule in the agreement, unless there is a medical challenge to your opinion; and :nat does not mean a statement from Doctor Joe Glow saying, "l think he is able to return to his regular occupation." Such a 112 Association of American Rail roads statement is not, in my coinion, evidence :hallenqlrc your , opinion after examination of ere ~an ` s condition--so '.'at a . ticn precedent to any medical panel -ust pe diametric co'nio's the medical condition of the -an. Without tnat 't fould re - lenged as oeir.g 30 ir^ropenly constituted or ordered meqicj: CHAIRMAN STCCX'JELL: Mr. Horsley amazes re. He uses tern "diametric" in a runner that I didn't quite enters tanc. cifically, what evidence does this emoloyes that r-as seen cito, fied require to dispute our decision coat r.a is physically ur,-.': t. MR. HORSLEY: Let's go to a case we are both familiti the reported syphilitic condition of a dining car waiter; arc v reprehensible that an organization should take it uo as not oew: in existence, but that is my example of two medical opinions the man has, the man has not, a trace of syphilis in his blood. CHAIRMAN STOCKWSLL: Mr. Horsley, are you saying that t-i medical panel should decide only on the physical condition of the employee and not decide whether he should go back to a specific occupation? MR. HORSLEY: That'll keep us here 2II day. I thinx thv. standards of physical fitness are inescaoably necessary. I tnir.x that a carrier doctor should decide whetner or not the subject meets the standards of pnysical fitness and that any other doctor should be told that his decision must relate to the standards of physical fitness; and I am afraid that his ability to rejoin the ranks of free, ful1-swinging brakemen -iding hicn. as we say, on these cars and jumping on and off and flipping ground switcr.es, an: so forth, is a matter for the railroad doctor only, because ^ou would have to qualify some other doctor wno knows nothing about it, and then ask him to give an opinion as to whether 3 man couid return to work. And he should say "1 have no opinion on that." So I believe it relates to standards of physical fitness. CHAIRMAN STOCKWELL: I certainly have to disagree. MR. HORSLEY: I know, I know. I am too dogmatic. CHAIRMAN STOCXWELL: With the three-doctor panel discuss ing the problem, there is very little medical disaoreement--*he -.n has diabetes, he is taking 40 units of insulin, there- is no meoicil disagreement, he has no unusual complications of his disease. MR. HORSLEY: You see how easy I am trying to make it for you, sir. You have in your standard of physical fitness this doors of diabetes, and if he falls within that and that is taboo, as far as his work is concerned, that's all the foreign doctor would have to decide upon and he would naturally agree with you. CHAIRMAN STOCKWELl: Well, that's real easy. If he would of Ararican Railroads Proceedings of .**0dica 1 Section vion, evidence challenging ..cur -ac:/ the man's condition--$o tret 3 >1 panel rust pe diametric coinions - 0 ran. without that it should ce cv. :y constituted or ordered medical "ce*-: Mr. Horsley amazes me. He uses f- that I didn't quite understand. ,-s tins employee that has teen d:$cuu. decision that he is physically unfit' . go to a case we are both familiar wiv 1 tion of a dining car waiter; anc it zation should take it uo as not heirexample of two medical opinions that , a trace of syphilis in nis blood. Mr. Horsley, are you saying that the only on the physical condition of tne ner he should go back to a specific Rurally agree with me, it would be the easiest thing in the . rid. I would love that. MR. HORSLEY: But you just said there is no disagreement j to his medical condition. CHAIRMAN STCCTWELL: No, but there is a lot of disagreeent as to whether he ought to get on the top of the box car. MR. HORSLEY: So we will keep that out of the area of dis :ute. CHAIRMAN STOCKWELL: But how do you keep it out of the Hspute, because this panel has to decide, does the man go tacx to ,-jrk or does he stay on sick leave? MR. WOLFE: Well, the answer, it seems to me ovious. You must have specifications, and the panel me whether the man fits within them, and that's the , is has iob fairly to deterof the edical panel. The specifications are established by management .irh their medical advisers1 assistance. 11 keep us here all day. I think that > are inescapably necessary. I think decide whether or not the subject :al fitness and that any other doctor ;i ust relate to the standards of `n that his ability to rejoin the brakemen riding high, as we say, on f off and flipping ground switches, arc railroad doctor only, because you her doctor wno knows nothing about it, pinion as to whether a man could d say "1 have no ooinion on that." So ards of physical fitness. I certainly have to disagree. , I know. I am too dogmatic. With the three-doctor panel discuss- little medical disagreement--the man units of insulin, there is no medical 1 complications of his disease. how easy I am trying to make it for indard of physic al fitness this degree jthin that and ".at is taboo, as far s all the forei g.n doctor would have Orally agree wi on you. "'ell, that's real easy. If he would 1 CHAIRMAN STOCKWEll: In other words, you're talking about he job now, not his physical condition? MR. WOLFE: I'm talking about the jcb and his physical con:ition for being able to do the job. That's all part of the speciications that should be established beforehand. The panel gets ;hose specifications. The only question that they answer is, does me man come within them or doesn't he? Then you have token care >f your panel in the proper way. Your panel doesn't get into the enagement side of it, the panei doesn't get into this area of '----*-------- "-k> 1 ' *>/ that u.o aro fa 1 ! CHAIRMAN STOCKWELl; Yes, Bob? DR. ROBERT EDMONDS, Norfolk & Western Railway: I have a specific case I am involved in now that I would like to address to Mr. Horsley. This concerns an engineer whom I disqualified. He had a coronary thrombosis in 1961. He had bilateral cataract opera tions in January of 1968. He had a second infarction in Auaust of 196A 8y labor agreement, should I downgrade him from a road engineer to a yard engineer? He has the right cf appeal to a threeman board located in the city of Peru, Decatur and Mcberly, Missouri. I can't have him come to Cleveland where we can have an adequate examination, and, furthermore, the decision of the thieesun hnarH ic bindina bv aareement 1941. DR. SUTHERLAND: You don't get to approve who that board is? IK Association of American Railroads OR. EDMONDS: I appoint cno mars. MR. WOLFE: How is the neutrai selected? OR. EDMONDS: The second ran is acpointed by the patien-, or labor, the s.m'rd .ran by mutual agreement. I don't have teat many friends in Per- that their friena could be my friend. CHAIRMAN STCC.KV.ELL: You wouldn't want to prejudice any. one, would you? OR. EDf'ONOS: I certainly wouldn't, but I would want the safety factor to be on my side. CHAIRMAN STOCKWELL: There is a question for Mr. Horsley. that? DR. EDMONOS: Mr. Horsley, you say I don't have to accept MR. HORSLEY: I don't remember saying you didn't have to accept that. Your procedure <s diagrammed all the viay through to final and binding conclusion by a three-doctor panel. OR. EDMONDS: In other words, labor has bargained away this right. MR. HORSLEY: But do you have a dispute in the first place with respect to his physical condition, a medical challenge to your doctor's opinion? That's what I just stated a moment ago. I think therein lies your objection to going through with this final and binding putting of a man back at work at wnicn you don't think he should work. OR. EDMONDS: You mean I have the right to refuse to put it to a third man, chat three-man board? MR. HORSLEY: Well, if there is no dispute as to his physi cal condition. OR. EDMONOS: There's no dispute. MR. HORSLEY: He has this coronary thrombosis, he has this later infarction. He has the-- OR. EDMONDS: Bilateral cataracts. MR. HORSLEY: All right, everybody agrees to that? DR. EDMONDS: There is no question. MR. HORSLEY: So there is no dispute, is there? of American Railroads Proceedings of Medical Section point one ran. the neutral selected? second ran is appointed by the patient -utual aqrcerent. [ don't have that -.eir friend could be my friend. : You wouldn't want to prejudice any- -tainiy wouldn't, but I would want the de. There is a question for Mr. Horsley, orsley, you say I don't have to accept `t remember saying you didn't have to is diagrammed all the way through to a by a three-doctor panel. r.er words, labor has bargained away p you have a dispute in the first place r 'tion, a medical challenge to `i ,t I just stated a moment ago. I stton to going through with this final back at work at which you don't think .an I have the right to refuse to put .-ran board? if there is no dispute as to his physi- s no dispute. this coronary thrombosis, he has this 'al cataracts. ''t, everybody agrees to that? s no question. ^ is no dispute, is there? [ j : t OR. EOMCilOS: Ther-e is a labor disoute because in the labor agreement should I either disqualify him or put nim in a posi tion of lesser importance--a three-man beard may be appointed. MR. HORSLEY: Then I say you're bound by the terms of your agreement, and that's something from which you can hardly be extricated if your procedure is all diagrammed in that immutaole fashion. 3ut you might find that you out him back on an eiqht-nour short-switc.ning yard engine and if he dies at the tnrottle because of the very condition that there's no dispute about existing, you're liable for suit under the Wrongful Death Act, for putting nim backhand there are two cases on that point ir. the courts. This is something to be looked at very, very carefully. CHAIRMAN STCCKWELL: vou see. Or. Edmonds, these gentlemen are avoiding the issue. Our problem is, that when a mecicai board is convened, we have to make the decision as to whether or not t.nat nan goes back to his job. DR. EDMONDS: I hate to put it this bluntly, but it's happened in this case--our labor people have bargained away my right to establish medical standards? CHAIRMAN STOCKWELL: Well, new, I will ask Mr. Wolfe to answer that question. Have they bargained away nis rights? MR. WOLFE: To a certain extent they have. I agree they have bargained away a certain part of the rights that you had by creating this panel, in the first place, and limiting it to ooctors from that particular area. 8ut to get back to avoiding your ques tion--I take issue with that; we don't say that the medical panel doesn't have the job of making the decision. What I say is that the medical panel should have guidelines which have been estab lished by the company in conjunction with its meaical experts for the medical panel to use. We had a case not too long ago, which involved a mental condition, and it went to a panel. The neutral doctor v?as a psychi atrist out on the road some place, and he was simply presented with this conductor who had a history of mental difficulties and going in and out of various sanitariums; and the question was, could he return to work? Could he return to what kind of work? This neutral doctor didn't know other than the fact that he was a railroad conductor. He ruled that the man was able to work, hold a job. 3ut that didn't answer my question at all as to whether he was able to work as a conductor in charge of through freight trains on our main line anc All that goes with it. And I say that these panels must have guide lines which are pre-established in order to assist the panel in making its decision. 116 Association of ican Failroads We have another case where we disqualified a mn bor.::.---. he was over.-;eig-t. !t -c.n; to a bcura and the board said didn't go to a pane', we went rignt thrcugn a board orccseoiru - Special Board of Adjust,rant on boat casa-and toe ooaro said, > must have qualifications and sopoi-'cations uecause "at -an entitled to know wnat your weight requirements are." f > Well, if that princioie is true, these men should <r:w i i what your specificatisns are in general, from a medical standee-And if your management present* it to them, then tney <now. if don't, you are rendering yourself vulnerable. Am I not right? i NR. HORSLEY: Yes, sir. CHAIRMAN STOCXV.'Etl: I can assure you that we have medic: standards. i t MR. WOLFE: Do you have medical standards-- \ \ CHAIRMAN STOCKV.&LL: For each specific job. ;r-.i MR. WOLFE: And do you have job specifications? a fie i CHAIRMAN STOCKNELL: Job specifications well outlined; but the difficulty is that the neutral may not agree with cur job spe l cifications and standards and he is the one that is entitled to ire- * i make the decision. MR. WOLFE: Not if the agreement which sends that case to a three-man panel includes your job and rreoical specifications. CHAIRMAN S70CKWELL: It is handled differently in all cases. In our case I personally participate. I meet with the physician for the employee and the neutral, and we discuss it, and that's why we win our cases. Actually, sending a long letter to the neutral outlining the job specifications, as you say, is fre quently a useless procedure because he doesn't read it. He just talks to the patient and asks the patient what does he have to do, and Joe says, "It's real easy. I ride in the caboose from Chicago to Detroit; no problem." MR. HORSLEY; There's a case now where the railroad has 3n engineer of 340 pounds who can't get his fat aoathy into his seat, but there's a dispute about it and no regulation as to the degree of obesity on the part of any employee. CHAIRMAN STOCKWELL; In Canada it is real easy. Dr. Wight will tell us about this. ,;u \ iccc i-.ar * i tt cb :j01 .oui -el - f.fu DR. WIGHT: Thank you. I have listened with considerable enjoyment to this discussion this morning. I think we're aettinn down to basics. But there are a few things that have disturbed me quite a bit, listening to all the talk this morning. Nr. Horsley roc t ct American Rail reads >sc where we disqualified a man because ; to a beard and the board said --it nt rignt through 5 board proceedin': : on that case--and tre board said, vj o specifications because that ran was weig.nt requi rerents are.' ciole is true, these men snoula knew g in general, from a reaical stanceoint. .ent it to them, then they knew, if you urseif vulnerable. An I not right? sir. : I can assure you that we have medical have medical standards-- : For each specific job. you have job specifications? : Job specifications well outlined; but neutral may not agree with our job spe nd he is the one that is entitled to * -greerrent which sends that case to /c job and medical specifications. It is handled differently in all ally participate. I meet with the :nd the neutral, and we discuss it, and Actually, sending a long letter to .b specifications, as you say, is frebecause he doesn't read it. He just s the patient what does he have to do, y. I ride in the caboose from Chicago 's a case now where the railroad has an jn't get his fat apathy into his seat, t and no regulation as to the degree employee. In Canada it is real easy. Or. Wight :u. I have listened with considerable this morning. I think we're getting -o a few things that have disturbed me 1 the talk this morning. Mr. Horsley Proceedings of Medical Section referred to medical standards. I don't know what he means by ecical standards. 3en, you say you have medical stanaarcs. Maybe ,cu have them. CHAIRMAN STOCKWELL: I hope we have. DR. WIGHT: 3ut they vary from railroad'to railroad, and the thing that is a little disturbing to me is, from wrat I *ave listened to this morning, tnat our medical standards = re ceing downgraded. You referreo to examinations not below the waist, examinations not before the ace of 50, examinations, at cetera at cetera. There doesn't seem to be any uniformity at ail. how, 'ere we1 re moving into an era wnen we have bigger trains, trains .moving faster, and we are lowering our standaras. I find this very, very disturbing, and I am going to suggest a Utopia. Maybe it will be many years before we get there, and I know that we hate legislation (we are surrounded by legislation now), but we have backed our selves into a corner right now. Medical standards seem to be one of the biggest bargaining sticks that are wielded by labor. "Tf you want to examine this man, we won't let you or we'll strike you,' and it is a very potent weapon; and I can't see any reason wry in a field of endeavor suen as we are in, that the government couldn't lay down minimal standards for running trains. This would not be creating a precedent. They have done it already with airlines; it's being agreed to nationally ana inter nationally. Set minimal standards below which no railway could go, and if we had standards such as this laid down, one of the .most potent weapons that labor has would be taken away from tnem. They couldn't threaten to strike you if you insisted on examining your locomotive engineer every two years or every three years or every year. I don't think it would be at all out of place if this Com mittee made a recommendation to the AAR that they in turn locoy-- "lobby" seems to be the word now--that Washington lay down minimal standards for the running trades of railways. They're suooosed to be interested in safety; and yet you.have stated--and i hate to quote you--but you have stated that one major railway in this country has abolished medical examinations. Others might just as well have abolished them, they are doing them at such infrecuent intervals. Others, you have no right to examine a man when he has been off sick. The case here somebody cited, struck me as so absolutely ridiculous. When a man comes back on crutches, this, that and the other thing, he must be allowed to go to work because there is nothing in the labor union that says he has to submit to an examina tion. I don't think we would be far out of field at all if we recommended something along this line to Washington. U8 Association of American Railroads We haven't reached this stage of Utopia in Canada, but ; hope we will some day. In our country, the only binding reculj. tions laid down cover the field of vision, color vision, and h5Jr, ing, and these are laid down by government, so we have no prooi?~. Union, nobody else, can argue. If a man's vision is below a cer tain standard, that's that. I throw this out for what it's worth. CHAIRMAN STGCKWELL: Or. Wight, early in this panel I suggested that one of the reasons for our concern was the National Transportation Safety Act of 1968. This is a very restrictive legislation. It might or might not include what you have suggest:-:, some required periodic physical examination program. Obviously, that would be good for us, but 1 think from the point of view of railway management and the AAR, that there 'would be accompanying regulations; there will be more regulation under the guise of safety that they have been opposed to. I think Mr. Risenda! can attest to that. There's been no unanimity of thinking as to the value of many of the provisions of the National Transportation Safety Act. , DR. WIGHT: But if they are thinking of revising it now, wouldn't this be a time to let them know that an august body such as this is interested in safety, and quoting Mr. Horsley, the gov ernment is interested in certain aspects of safety. They lay down regulations covering the distance of the ccw-catcher from the top of the rail, as to the mechanical equipment; but they are aoparently not interested in the man who is in charge of all these things. CHAIRMAN STOCKWELL: Dr. wight, we have a problem. We are all cognizant of it; that's why we are having this panel. I'm sorry; our time is up. I thank the members of the panel for their participation, as well as all of you. Thank you very much. (Applause) (Dr. longeway resumed the Chair.) CHAIRMAN LONGEWAY: Gentleman, there will be about a three minute break while we set this up. While we are waiting, we have a very distinguished guest that I would like to introduce. Mr. Man ion just came in a few min utes ago. Mr. Kanion, would you take a bow? (Applause) (Recess) CHAIRMAN LONGEWAY: If.everyone will take their seats, we will start this next session. -.-it i",. * ."liCC' ,,5 Of tC- .`-icnal 's:or> o' :-:V.ng 0-- ; yOU wi0 -'ve a lot 'cuscry. ;ood rese-. *)> arou< appears .as asked .c-rved A1 '.pink, ha' a railreae screening, of biocr-.' ,ould the thought 1 in Octets if we wou felt that essence, into in a cone. "atari a! i were in in a th:the resne borhoo-d bi ocnc'O sent to other o' the pat: of Ar^ric?n Sail roads Thank you. i certainly would fee in thank Mr. Manion for comino out and tainly das been a distinct pleasure and ;ej i a little ceremony and have Or. Rosen Strange, but he has gone so I guess that. een an honor and a privilege to serve I certainly want to thank the Commit - cooperation. I have enjoyed it tremenJohnson said in a very similar urned for this year, ned at 10:00 o'clock a.m.) Proceedings cf Medical Gecticn MEDICAL SECTION MEMBERSHIP (Voting representatives of Association of American Railroads full Membership Roads are listed directly oelow railroad name.) ^Indicates after name, not a Voting Railroad 'Indicates attendance at 1969 Membership Meeting AKRON, CANTON 4 YOUNGSTOWN RAILROAD: E. R. Hostetler, President a General Manager, Akron, Ohio AIGQMA CENTRAL .RAILWAY: L. C. Waugh, President 4 General Manager, Sault Ste. Marie, Ontario, Canada ALTON 4 SOUTHERN RAILROAD: Vivien P. Siegal, M.O., Medical Director, East St. Louis, Illinois H. 0. Hoffman, Vice president 4 General Manager, East St. Louis, Illinois ATCHISON, TOPEKA 4 SANTA FE RAILWAY: *0tto L. Hansen, System Medical Director, Chicago, Illinois ATLANTA & ST. ANDREWS BAY RAILWAY: Paul R. Flowers, M.D., Chief Medical Officer, Dothan. Alabama BANGOR & AROOSTOOK RAILROAO: P. H. Swales, Vice President Operations 4 Maintenance, Bangor, Maine BELT RAILWAY COMPANY OF CHICAGO William J. Reilly, M.Q., Medical Examiner, Chicago Illinois BESSEMER AND LAKE ERIE RAILROAD: John L. Thomas, M.O., Chief Surgeon, Greenville, Pennsylvania BOSTON 4 MAINE CORPORATION: J. Robertson Knowles, M.D., Chief Surgeon, 8oston, Massachusetts C. F. Yardley, Vice President-Operations, Boston, Massachusetts 8UFFAL0 CREEK RAILROAD: William E. Mishler, M.D., Chief Surgeon, Cleveland, Ohio CAM8RIA 4 INDIANA RAILROAO: R. J. Kent, President, Bethlehem, Pennsylvania CANADIAN NATIONAL RAILWAYS: *Peter Vaughan, M.O., Chief Medical Officer, Montreal, Quebec, Canada 205 Association of American Railroads CANADIAN PACIFIC RAILWAY: *G. Earle Wight, M.Q., Chief of Medical Services, Montreal Quebec, Canada S. M. Gossage, Vice President, Montreal, Quebec, Canada CENTRAL OF GEORGIA RAILWAY: John G. Sharpley, M.D., Chief Surgeon, Savannan, Georgia CENTRAL RAILROAD COMPANY OF NEW JERSEY :# Frank W. Mahoney, M.O., Medical Director, Elizabeth, New Jersey CHESAPEAKE & 0HI0-8ALTIMQRE 4 OHIO RAILROADS: Isadora Kaolan, M.D., Director of Medical Services, Baltimore, Maryland R. C. Boelkins, M.D., Regional Medical Surgical Director, Grand Rapids, Michigan R. R. Brandon, M.D., Regional Medical Examiner, Huntington, West Virginia C. V. Cowan, Vice President Operations, Baltimore, Maryland John M. Emmett, M.D., Chief Surgeon, Richmond, Virginia CHICAGO & EASTERN ILLINOIS RAILROAD: *E. T. Rouse, M.D., Chief Medical Officer, St. Louis, Missouri CHICAGO & ILLINOIS MIDLAND RAILWAY: Robert J. Patton, M.D., Superintendent of Medical Department, Springfield, Illinois CHICAGO & NORTH WESTERN RAILWAY: Thomas A. Speer, Medical Oirector, Chicago, Illinois CHICAGO & WESTERN INDIANA RAILROAD: V. Tauras, M.D., Chief Medical Consultant, Chicago, Illinois CHICAGO, BURLINGTON & QUINCY RAILROAD: Harold W. Hairmatt, M.D., Chief Medical Officer, Chicago, Illinois CHICAGO, MILWAUKEE, ST. PAUL & PACIFIC RAILROAD: Raymond Householder, M.D., Chief Surgeon, Chicago, Illinois James F. Oepree, M.D., Chief Surgeon (Lines West), Seattle, Washington CHICAGO, ROCK ISLANO & PACIFIC RAILROAO: Johannes M.L. Jensen, M.D., Chief Surgeon, Chicago, Illinois CHICAGO, SOUTH SHORE & SOUTH 8EN0 RAILROAD:? Peter J. Pilecki, M.D., Chief Surgeon, Michigan City, Indiana CHIHUAHUA-PACIFIC RAILWAY: Ing. Jesus Manuel Excudero Costa, General Manager, Chihuahua, Chihuahua, Mexico CLINCHFI K. S. NC' COLOR-:' *Wa: J. ,, DELAWARE Will DENVER i *E. ; DETROIT Earl DETROIT B. n DETROIT. Lawn oiRcce:: C. Ir DULUTH, *Howa ELGIN, J Medic ERIE la: Will - FERRCCAA Edua. 0& FLORIDA W. I FORT WC W. r N. A SALVES" Wei - GEORGIA Lam- GRAND ' *3. J. G. t of American Railroads Shief of Medical Services, Montreal, ^sident, Montreal, Quebec, Canada , Chief Surgeon, Savannah, Georgia NEW JERSEY:? , Medical Director, Elizabeth, : & OHIO RAILROAOS: nrector of Medical Services, regional Medical Surgical Director, :ional Medical Examiner, Huntington, ent Operations, Baltimore, Maryland ief Surgeon, Ricnmond, Virginia RAILROAD: f Medical Officer, St. Louis, Missouri RAILWAY: Sv intendent of Medical Department, LWAY: 1 Director, Chicago, Illinois AILRQAD: edical Consultant, Chicago, Illinois Y RAILROAD: , Chief Medical Officer, Chicago, . 4 PACIFIC RAILROAD: ., Chief Surgeon, Chicago, Illinois lief Surgeon (Lines West), Seattle, 'IC RAILROAD: 0., Chief Surgeon, Chicago, Illinois i BEND RAILROAD:# Chief Surgeon, Michigan City, Indiana *o Costa, General Manager, Mexico TT Proceedings of Medical Section 207 ClINCHFIELD RAILROAD: K. S. Tanner, Jr., M.D., Chief Surgeon, Rutherfordton, North Carolina COIORAOO 4 SOUTHERN RAILWAY: Walter J. Lcngeway, M.D., Chief Surgeon, Denver, Colorado *J. W. Terril, Vice President, Denver, Colorado OELAWARE 4 HUDSON RAILROAD: William H. De Rouville, M.D., Chief Surgeon, Albany, New York DENVER & RIC GRANDE WESTERN RAILROAD: *. A. Sampson, Manager of Medical Service, Denver, Colorado DETROIT 4 MACKINAC RAILWAY: Earl B. Davis, General Claim Agent, Tawas City, Michigan DETROIT 4 TOLEDO SHORE LINE RAILROAD: 6. W. Stockwall, M.D., Chief Surgeon, Cetroit, Michigan DETROIT, TOLEDO 4 I RONTON RAILP.OAO: Lawrence S. Fallis, M.D., Chief Surgeon, Detroit, Michigan DIRECCION GENERAL DE FERROCARRILES EN OPERACICN: C. Ing. Miguel A. Barberena, General Director, Mexico, O.F. DULUTH, MISSA8E 4 IRON RANGE RAILWAY: Howard J. Meyer, M.O., Chief Surgeon, Ouluth, Minnesota ELGIN, JOLIET A EASTERN RAILWAY: Medical Director, Chicago, Illinois ERIE LACKAWANNA RAILWAY: William E. Mishler, M.D., Chief Surgeon, Cleveland, Ohio FERROCARRIL DEL PACIFICO, S.A. DE C.V.: Eduardo Contreras Reyna, M.D., Chief Surgeon, Guadalajara, Jalisco, Mexico FLORIDA EAST COAST LINE RAILWAY:# W. L. Thornton, President, St. Augustine, Florida FORT WORTH 4 DENVER RAILWAY: W. ?. Higgins, Jr., M.D., Chief Surgeon, Fort Worth, Texas N. A. Kilgore, M.O., Chief Medical Officer, Houston, Texas GALVESTON, HOUSTON 4 HENDERSON RAILROAD: Weldon W. Stephen, M.D., Chief Surgeon, Galveston, Texas GEORGIA RAILROAD: Lamar F. Glass, M.Q., Chief Surgeon, Atlanta, Georgia GRAND TRUNK WESTERN RAILWAY: *B. W. Stockwell, Chief Surgeon, Detroit, Michigan J. W. Oemcoe, V.P. and General Manager, Detroit, Michigan G. E. Dimond, M.O., Asst. Chief Surgeon, Detroit, Michigan rr?r i f 208 Association of American Railroads GREAT NORTHER:'! RAILWAY: "Abbott Skinner, M.D., Chief Medical Officer, St. Paul, Minnesota J. L. Robinson, Vice President, St. Paul, Minnesota GREEN SAY 4 WESTER?! RAILROAD: H. Weldon McGee, President, Green 3ay, Wisconsin GULF, KC8ILE' S OHIO RAILROAD: G. P. Brock, President, Mobile, Alabama HOUSTON SELT 4 TERMINAL RAILWAY: Bill Rooins, M.D., Chief Surgeon, Houston, Texas ILLINOIS CENTRAL RAILP-OAO: Harry L. Hunter, M.D., Chief Medical Officer, Chicago Illinois ILLINOIS TERMINAL RAILROAD: H. 0. Johnson, Secretary 4 General Solicitor, St. Louis, Missouri JACKSONVILLE TERMINAL COMPANY:# J. M. Masucci, M.D., Chief Medical Officer, Kansas City, Missouri D. E. Farrar, Vice President-Personnel, Kansas City, Missouri KANSAS CITY TERMINAL RAILWAY: William H. Duncan, M.D., Chief Surgeon, Kansas City, Missouri KENTUCKY 4 INDIANA TERMINAL RAILROAD: 0. J. Gaynor, President 4 General Manager, Louisville, Kentucky ` LAKE SUPERIOR 4 ISHPEMING RAILROAO: Matthew C. Sennett, M.D., Chief Surgeon, Marquette, Michigan : LEHIGH VALLEY RAILROAD: : John Niles, M.D., Chief Surgeon, Sayre, Pennsylvania LONG ISIANO RAILROAD:# Vincent Cap02zi, M.D., Chief Medical Examiner, Jamaica, , New York [ LOUISIANA 4 ARKANSAS RAILWAY: ' J. M. Masucci, M.D., Chief Medical Officer, Kansas City, ^ Missouri LOUISVILLE & NASHVILLE RAILROAO: t J. M. Terry, General Attorney, Louisville, Kentucky *A. J. Sutherland, M.D., District Surgeon, Nashville, o Tennessee V `i MCCLOUD RIVER RAILROAO: * Chief Surgeon, McCloud, California MI'.' MISS- -T mcn: NAT: L NEVA' nt* NCR= C IAU.m"NO?' ON'A PENN *$ J * of American Railroads ., Chief Medical Officer, St. Paul, President, St. Paul, Minnesota _*OAC : >icent, Green 6ay, Wisconsin .RCAO: n, Mobile, Alabama .RAILWAY: '.ief Surgeon, Houston, Texas :0: Chief Medical Officer, Chicago .'AO: :ary & General Solicitor, St. Louis, MPANY Chief Medical Officer, Kansas City, esident-Personnel, Kansas City, Missouri :LWAY: .0., Chief Surgeon, Kansas City, Missouri MIA1 RAILROAD: :n Seneral Manager, Louisville, -G RAILROAD: M.O., Chief Surgeon, Marquette, Michigan ef Surgeon, Sayre, Pennsylvania , Chief Medical Examiner, Jamaica, LWAY: Chief Medical Officer, Kansas City, AILROAO: Attorney, Louisville, Kentucky D-> District Surgeon, Nashville, d, California Proceed!ngs of .Medical Section MAINE CENTRAL RAILROAD: J. W. Wiggins, Vice President, Cper3tinc-ngines,`ing Departments, Portlarc, Maine MANUFACTURERS RAILWAY: W. M. Daugntrey, Vice President, St. Louis, Missouri MINNEAPOLIS, NORTH FI EL 0 S SOUTHERN RAILWAY: H. E. Pence, President, Minneapolis, Minnesota MISSOURI-KANSAS-TEXAS RAILROAD: *Roland S. Kieffer, M.D., Medical Director, St. Louis, Missouri MISSOURI PACIFIC LINES: *E. T. Rouse, M.Q., Chief Medical Officer, St. Louis, Misscur MONON RAILWAY: James R. Hines, M.D., Chief Surgeon, Chicago, Illinois NATIONAL RAILWAYS OF MEXICO: 0. Magro G., M.D., Chief of Medical Department, Mexico, D.F.. Mexico NEVADA NORTHERN RAILWAY: H. M- Peterson, Vice President & General Superintendent, East Ely, Nevada NEW YORK, SUSQUEHANNA & WESTERN RAILROAD:? Edward Oana, M.D., Chief Surgeon, Edgewater, New Jersey NORFOLK & WESTERN RAILWAY: J. K. Humphries, M.D., Medical Oirector, Roanoke, Virginia L. C. Ball, M.D., Regional Medical Oirector, Roanoke, Virgini C. M. 8enage, M.O., Regional Medical Oirector, St. Louis, Missouri R. W. Edmonds, M.O., Regional Medical Director, Cleveland, Ohio NORFOLK SOUTHERN RAILWAY: Robert L. Payne, Jr., M.O., Chief Surgeon, Norfolk, Virginia NORTHERN PACIFIC RAILWAY: *A. McEwan, M.D., Chief Surgeon, St. Paul, Minnesota ONTARIO NORTHLAND RAILWAY: E. A. Frith, General Manager & Chief Executive Officer, North Bay, Ontario, Canada PENN CENTRAL COMPANY: *Stanley J. Cyran, M.D., Asst. Vice President-Medical Services Philadelphia, Pennsylvania David W. Bishop, M.O., Regional Medical Director, Altoona, Pennsylvania 0. T. Lynch, General Claims Attorney, New York, New York J. D. Thornton, M.Q., Regional Medical Director, Chicago, Illinois 210 Association of A-er-'can Railroads PENN-READ I `/G SEASHORE LINES: R. E. Blosser, General Manager & Traffic Manager, Camden, New Jersey PEORIA 3, FEK1N UNION RAILWAY: R. M. Sutton, M.3., Chief Surgeon, Medical Surgical Clinic, Peoria, Illinois PITTSBURGH & SHAWX'JT RAILROAD: W. E. Buhite, President, Kittanning, Pennsylvania PRESCOTT & NORTHWESTERN RAILROAD: Jacob B. Hesterly, M.D., Chief Surgeon, Prescott, Arkansas PULLMAN COMPANY: ' A. H. Lobeck, Vice President, Operations, Chicago, Illinois *R. M. Graham, M.D., Consultant, Chicago, Illinois RAILWAY EXPRESS AGENCY, INC.: r W. J. Taylor, President, New York, New York Kenneth L. Matson, M.D., Local Surgeon, Chicago, Illinois RARITAN RIVER RAILROAD: R. G. Kipp, General Manager, South Amboy, New Jersey ; READING COMPANY: , Morton M, Medvene, M.D., Chief Medical Officer, Philadelphia, ; Pennsylvania : RICHMOND, FREDERICKSBURG & POTOMAC RAILROAD: Adney K. Sutphin, M.O., Chief Medical Director, Richmond, Virginia ; ST. LOUIS-SAN FRANCISCO RAILWAY: Vencel W. Hollo, M.D., Chief Surgeon, St. Louis, Missouri ; ST. LOUIS SOUTHWESTERN RAILWAY: i John C. Farris, M.D., Chief Surgeon, Texarkana, Arkansas . SEABOARD COAST LINE RAILROAD: 3 Adney K. Sutphin, M.O., Chief Medical Director, Jacksonville, Florida | S00 LINE RAILROAD: t Lowell W. Weber, M.D., Medical Director, Minneapolis, * Minnesota ", Mark C. L. Hanson, M.D., Medical Oirector, Minneapolis, VM Minnesota %. SOUTHERN PACIFIC COMPANY: | *Vance M. Strange, M.Q., Chief Surgeon, San Francisco, y California | Joe R. Gandy, M.D., Chief Surgeon, Houston, TexasI I SOUTHERN RAILWAY: \ *Max P. Rogers, M.D., Chief Surgeon, Washington, D.C. H. J. TEXAS TEXAS B. tole: unicx <: a Ha UNION >,. *Pa WEST! a WEST' WEST b WINS ASS *F o i- ;n o f American Railroads ES: , Manager 4 Traffic Manager, Camden, .WAY: ief Surgeon, Medical 4 Surgical Clinic, .TOAD: c, Kittanning, Pennsylvania -All WAD: Chief Surgeon, Prescott, Arkansas }$ident, Operations, Chicago, Illinois .nsultant, Chicago, Illinois INC.: t, New York, New York Local Surgeon, Chicago, Illinois :nager, South Amboy, New Jersey )., Chief Medical Officer, Philadelphia, 4 OMAC RAILROAD: ., (..lief Medical Director, Richmond, <AU WAY: , Chief Surgeon, St. Louis, Missouri ILWAY: Chief Surgeon, Texarkana, Arkansas 0A0: , Chief Medical Director, Jacksonville, Medical Director, Minneapolis, Medical Oirector, Minneapolis, , Chief Surgeon, San Francisco, Ief Surgeon, Houston, Texas hief Surgeon, Washington, O.C. Proceedings of Medical Section__ 211 SPOKANE, PORTLAND 4 SEATTLE RAILWAY: Marl L. Margason, M.D., Medical Director, Portland, Oregon TENNESSEE, ALABAMA 4 GEORGIA RAILWAY : E. M. Tolleson, President, Chattanooga, Tennessee TERMINAL RAILROAD ASSOCIATION OF ST. LOUIS: H. H. Klein, General Claim Agent, St. Louis, Missouri J. H. Sharp, President, St. Louis, Missouri TEXAS & PACIFIC RAILWAY: Harold P. Bray, M.D., Chief Surgeon, Marshall, Texas TEXAS MEXICAN RAILWAY: B. F. Wright, Jr., Vice President 4 General Manager, Laredo, Texas TOLEDO, PEORIA 4 WESTERN RAILWAY: Charles 0. 8ranch, M.O., Chief Surgeon, Medical 4 Surgical Clinic, Peoria, Illinois TORONTO, HAMILTON 4 8UFFAL0 RAILWAY: N. E. Price, M.D., Chief Medical Officer, Hamilton, Ontario, Canada UNION PACIFIC RAILROAD: Ed H. Bailey, President, Omaha, Nebraska Harold B. Lamb, Medical Consultant, Salt Lake City, Utah UNION RAILROAD: W. S. Miller, General Manager, East Pittsburgh, Pennsylvania *Paul D. Prather, M.D., Medical Director, East Pittsburgh, Pennsylvania WESTERN MARYLANO RAILWAY: Gilbert W. Benjamin, M.D., Chief Medical Officer, Baltimore, Maryland WESTERN PACIFIC RAILROAD: *Max E. Childress, M.D., Chief Surgeon, San Francisco, California WESTERN RAILWAY OF ALA8AMA-ATLANTA 4 WEST POINT: Lamar F. Glass, M.D., Chief Surgeon, Atlanta, Georgia WINSTON-SALEM S0UTH8CUND RAILWAY: F. S. Morrison, Vice President 4 General Manager, WinstonSalem, North Carolina Louis Shaffner, M.D., Chief Surgeon, Winston-Salem, North Carolina ASSOCIATION OF AMERICAN RAILROADS: *Thomas M. Goodfellow, President, Washington, D. C. *R. R. Manion, Vice President-Operations 4 Maintenance Department, Washington, D. C. *F. J. Parker, Asst. Staff Secretary, Operating-Transportation Division, Washington, D. C. 212 Association of American .'ai'roads ASSOCIATION OF AFRICA:; RAILROADS CONTINUED: *J. A. Risencal, Director, General Claires Division, Washington, D. C. *J. A. Schulte, Vice ^resident, Public Relations Department, Washington, 0. C. *0. A. Sherman, Assistant Director, General Claims Division, Washington, 0. C. *W. t. Todd, Staff Secretary, Operating-Transportation Division, Washington, D. C. HONARARY MEMBERS - RETIRED J. J. Sradabur, M.O., 1202 C.iO. 3uilding, Huntington, West Virginia John M. Brewster, M.3., 311 Hilloale Road, Villanova, Pennsylvania Milton B. Clayton, M.O., 266Q Connecticut Avenue, N.W., Washington, 0. C. Glenn F. Cushman, M.O., 76 Cerritos Avenue, San Francisco, California B. I. Derauf, M.D., 2216 Rosewood Lane 5., St. Paul, Minnesota K. E. Dowd, M.D., S9 Bal Four, Mount Royal, Quebec, Canada A. M. W. Hursh, M.Q., 5450 Wissahickon Avenue, Philadelphia, Pennsylvania Raymond B. Kepner, M.O., 1923 Suffolk Lane, Indianapolis, Indiana Harvey -Nelson, M.D., 146 B-N.W. 41st Ct., Pompano Beach, Florida Southgate Leigh, Jr., 300 Colonial Avenue, Norfolk, Virginia A. Neupauer, M.O., 50 S. Penn Street, Hatboro, Pennsylvania Ernest C. Olson, M.O., 8232 S. Crandon Avenue, Chicago, Illinois J. Huber Wagner, M.O., c/o St. Francis Hospital, Pittsburgh, Pennsylvania Albert H. Winters, M.D., No. 40 P&IE Annex 8uilding, Pittsburgh Pennsylvania Ray S. Westiine, M.D., 548 Buena Vista, Edwardsville, Illinois GUESTS AMERICAH HEART ASSOCIATION Loring Brock, M.D., Chief, Coronary Rehabilitation and Work Evaluation Unit CHICAGO i NORTH WESTERN RAILWAY James K. Stack, M.O., Chief Surgeon, 400 West Madison Street, Chicago, Illinois J. Wolfe, Vice President, Labor Relations, Chicago, Illinois COLORADO, STATE OF Ted Bach, Deputy Secretary of State - Colorado, Denver, Colorado Duke Dunbar, Attorney General, State of Colorado, Denver, Colorado CGLC e. color.-:. : Gera' Ct: Eric SCr: DENVER D. M. Den NATIONAL El lav. Chi ST. LUKE Fred Ce.n SOUTHERN S. S. Sar. H. C. Hos N. . San TECHNICS Clauc Oonal New UNITED A C. R. UNITED S Colon Ent Color UNITED S i Scott *r v  r American Railroads________ hlfcaos continued: t , General Claims division, rodent, Public Relations Deoartment, -it Director, General Claims Division, :tary, Operating-Transocrtation Division, 202 C.&O. Building, Huntington, , 311 Hilldale Road, '/Ulanova, , 2660 Connecticut Avenue, N.W., 76 Cerritos Avenue, San Francisco, 5 Rosewood Lane $., St. Paul, 1 Four, Mount Royal, Quebec, Canada 450 Wissahickon Avenue, Philadelphia, , 1923 Suffolk Lane, Indianapolis, 6 3-N.W. 41st Ct., Pompano Beach, 90 Colonial Avenue, Norfolk, Virginia , Penn Street, Hatbcro, Pennsylvania A? ". Crandon Avenue, Chicago, c/o St. Francis Hospital, Pittsburgh, , Mo. 40 P&LE Annex Building, Pittsburgh, 548 8uena Vista, Edwardsville, Illinois GUESTS f, Coronary Rehabilitation and Work 1 ,`AY if Surgeon, 400 West Madison ' iS , Labor Relations, Chicago, Illinois :ry of State - Colorado, Denver, 'reral, State of Colorado, Denver, Proceed i ns of >'edi sal Secti oh i- i COLORADO, STATE OF (CONTINUED) Geraid Starkey, Jr., M.D., Vedicai Co-CJrdinatcr, Oapartr of Safety and Excise, State of Color:.oc, Server, Cole? V. E. Wohlauer, M.Q., M.R.H., Chief izi irgency Health Services Section, Colorado Oepartmen t of Health, State Colorado, Denver, Colorado COLORADO STATE MEDICAL SOCIETY William Covode, M.D., President, Denver, Colorado COLORADO & SOUTHERN RAILWAY E. C. Ackerman, Superintendent, Denver, Colorado COLORADO, UNIVERSITY OF Gerald Rainer, M.D., Assistant Professor of Surgery, Denver, Colorado Eric Rat2er, M.D., Assistant Chief of Surgery and Director of 3onfils Tumor Clinic, Denver, Colorado DENVER ANO RIO GRANDE WESTERN RAILROAD COMPANY 0. M. McEndaffer, Medical Consultant, 4810 E. 5th Avenue, Oenver, Colorado NATIONAL RAILROAD ADJUSTMENT BOARO Ellsworth T. Horsley, Attorney, 433 W. Van Suren Street, Chicago, Illinois ST. LUKES HOSPITAL Fred Schoonmaker, M.D., Oirector of Cardio Vascular Laboratory, Denver, Colorado SOUTHERN PACIFIC COMPANY S. B. 3urton, Assistant General Manager, 65 Market Street, San Francisco, California H. C. Hinshaw, M.O., Assistant Chief of Staff, Harkness Hospital, San Francisco, California N. . Williamson, Scecial Assistant, 65 Market Street, San Francisco, California TECHNICCN CORPORATION Claude Arnold, Regional Manager-West, Tarrytown, Mew York Donald L. Smith, General Manager-Clinical Division, Tarrytown, New York UNITED AIR LINES C. R. Harper, M.D., Regional Medical Director, Denver, Colorado UNITED STATES AIR FORCE Colonel Louis Kossuth, Command Surgeon, Air Defense Command, Ent Air Force Base, Colorado Colonel Charles W. lipp, Cormand Surgeon, U.S. Air Force Academy Hospital, Colorado UNITED STATES FEDERAL 8UREAU OF INVESTIGATION Scott Werner, Special Agent in Charge, Oenver, Colorado