Document xz7nNn9b1z6b2DNjQxxjnvyGG

ROWLAND D. GOODMAN, 2nd, M.D., P.A. 201 SO. LIVINGSTON AVENUE LIVINGSTON. NEW JERSEY 07039 TELEPHONE 994-9295 REVIEW VERY EXTENSIVE RECORDS DEATH CASE REPORT RE: Lawrence Colby DATE: 10/22/92 HISTORY: This 55 year old male died on 5/5/89, an autopsy was performed showing the cause of death to be the following: a scar adenocarcinoma of the lung involving the liver which was enlarged to 3400mg.he also had bilateral pleural involvement, small bowel, lymph nodes and adrenal gland metastasis; there was enlarged spleen as well as other lesions which were found but were not directly and causally related to his death. The autopsy showed on both pleural surfaces indurated nodularities ranging from sand grain size to 0.5cm in single dimension; the liver weighed 3400 grams and showed multiple multifocally confluent tumor nodules measuring up to 8cm maximum; the prostate was free of any tumor nodules or cancer. INDUSTRIAL HISTORY: The patient was employed by Union Carbide - 0TD from 1960 to 1967. While there he worked as a supervisor and shop steward on the assembly line in the packaging department. As a result he was exposed to polyethelenes and PVC pellets and powder. The concentrations of these chemicals were heavy because of the intensity and density of the PVC product and its monomer which made it difficult to breathe. He also worked with polyvinyl chloride (PVC), vinyl chloride monomers (VCM), polyethelene, poly urethane, polystyrene, isopropilidene, dispenal resins and phenols as well as lubricants and fuels, there were also fumes from the heat sealers in the vinyl resin bag packing bay. Of these chemicals vinyl chloride and phenols have been identified by the N.J. State Department of Health as carcinogens. The patient constantly complained to his wife about the exposure to the dirt and products that were packaged and referred to as PVC. The plant had no ventilation, the working conditions were bad. He would come home with white dust over his clothing which he removed befere entering the house. These were cleaned at a laundromat. He constantly spit up white mucous and his nose, eyes and ears were irritated. His nose bled on many occasions. The while powder irritated his feet and face which would get red. REL RECORDS: A page by page review has been made of a temendous number of records in this case. The following relavent ones abstracted: Riverview Hospital 4/5/81 - diabetes mellitus; malignant hypertension; urinary tract infection. This indicates the patient was a heavy smoker and had heavy ethynol intake but the quantities are not given in any detail. Same Hospital 7/10/83 - cirrhosis of the liver; diabetes mellitus; dehydration. There is no liver biopsy report in this record. Same hospital 3/7/89 - no final diagnosis but the admission impression was TIA; cancer of the pancreas; r/o metastatic disease to the brain and diabetes mellitus. UCC 075840 -2- re: Lawrence Colby REL RECORDS (continued) Riverviev Hospital 2/1/89 - adenocardinoma, metastatic to liver with unknown primary; COPD; reactive depression plus others. Same Hospital 7/10/83 - cirrhosis of the liver; diabetes mellitus; dehydration. This indicates patient smoked 2 packs of cigarettes daily and admits to heavy ethynol intake. R. Commentucci, M.D. 6/24/86 -- this indicates patient smokes 2-3 packs of cigarettes daily, drinks at least a 6 pack of beer daily. It also confirms that he worked with polyvinyl chloride*for 8 years but had not worked with the chemicals for the past 17 to 18 years. It also indicates the patient states he was exposed to over 100 times the present acceptable dose of the chemical on a daily basis. Request for admission dated 9/4/91 indicating that Union Carbide Corporation shipped vinylchloride resins to the OTD facility. Answer to interrogatories indicating the defendant was aware of the nature of the medical problems as a result of the patient's exposure to PVC and other chemicals and conditions existing in the defendant's plant. U.S. Department of Health Education and Welfare request for health hazard evaluation listing the hazards at the Amboy Terminating Company the same chemicals as listed above. Defendant's answers to plaintiff's interro gatories undated - this was reviewed but not relied on in coming to the conclusion reached below. Additional defendant's answers to plaintiff's supplemental interrogatories again reviewed but not relied on. Defendant's statement of facts under the heading "U.S. District Court for the District of N.J." was reviewed but not relied on. Report of 0. Aroback M.D. 6/25/90 also reviewed but not relied on. Report of S.S. Epstein, M.D. 8/15/89 also reviewed. CONCLUSION: On the basis of the information submitted in this case it is my opinion that this patient died on 5/5/89 of the causes stated in the autopsy report namely adenocarcinoma of the lungs with metastesis to the liver, bilateral pleurae, small bowel, lymph nodes as shown as shown in the report. It is further my opinion that there is direct causal relationship between the industrial exposure to identified carcinogens as described in the history above particularly vinylchloride monomers and phenols. In my opinion these substances were inhaled by the patient while employed at Union Carbide - OTD, they entered the cells of the lungs where they produced a derangement of the DNA resulting in cells which grew in an uncontrolled fashion which clinically is known as cancer. Therefore as a result of this DNA genetic derangement the patient developed characteristic symptoms and complaints of adenocardinoma of the lungs, the diagnosis was clearly established during his numerous hospitalizations and confirmed in the autopsy findings. There is therefore causal relationship between the exposure to carcinogens described above and the patient's death on 5/5/89 of the causes stated in detail in the autopsy report. R.D. Goodman, M.D. /sk ucc 075841 of Death in my fiice- It is acOiptaoJ.< wiu Date Issued: OCT IT 1989 REGISTRAR OF VITAL STATISTICS Borough of Red Bank, Monmouth _________________County, State of Nev Jersey ,\ (\ V'J 1 KAMI or MOLAMO P-* New Jersey State Department of Health CERTIFICATE OF OEATH STATE USE ONLY Lawrence A. ) KI 4.04tf Of mr 4* ACC - Uf I , MinJ Colby 4k IMHIfUA V.UnM* 1 Bat v 5/5/1989 " IITT" **** M 10/21/193(3 5:5 1]<. rM^CMa. Of O04tAATV*ty' . . HOSPITAL: OTHER: 152-24-8880 INPATIENT HCUrMUHilllWAMMtfXTOTMati R/OUTPATENTJt JOOOA NURSING on/IRWHlOCflAli HOME 0 RESIDENCE (4 c<Kin ............................... O OTHER (Specify) Rivervlew Medical Center v at PMC( Ituw V COWnr v cmroaiowr NJ Monmouth Middletown reacts** iMlNALACf lCm 4 Sum. Iumui O'i.iitI tv OtCtOCNTtVtaMUS AAMCO Jersey City. N.J 12 KJNVI'.ING *TOUSt < Wita. < 5Syes GNO <1 Red Bank Boro V JTatttAMMUMMt* Twp . 502 ns.IS* * WAA OATIS HinmTn Korea Mackey Ave. Monmouth 4. IN-UOt CTTT LMI'SI m l* COM Xyes ONO 07718 tl. UAAttAl f lAlUS C NEVER MARRICO WIDOWED .I^MARRIEO 0 DIVORCED ru(MU < NOUSTKT Phvllis Calabrese Itii&tMOillMSSOf lAtl (WlOTIft Operating Engineer Cons truction Suilding & Trades Union Local 825 Little Falls. N.J. 8 WHITE BLACK 3QAMER. INOIAN 4Q OTHER (Specify): * U. SfKfT17 Of MtSfAmCOfUOrN* yesXRno ! MEXICAN 30 CUBAN 50 OTHER (Specify): 20 PUERTO StCAN CENT/SO. AMERICA It MM Of fATM* ftvWI M. MMOCo MAMt Of MOTH0#HI lt MM to. Mctofwrs <oucaio* m#wiG>i Cmaw 15 Lawrence X. Colbv 21 MM Of MOMOUf Phvllis Colbv u nmm of arc*< on cmmaiput Bav View Cemetery 21*. NAM AM AOOACSS Of HMCKAL KM Jlk BEIA* Wife Dotothv 1S2. eDhkOw*a1liOnMd JjE) BURIAL CREMATION OTHER (Specify! ihCflYMimm Middletown Twd. ENTOMBMENT |J2 I1.lt ! M ,-Jx. John F. Pfleeer U HONAtVAt Of HIMEAAi. WttCtOa Funeral Home Inc.115 Tindall Rd. Middletown, N.J. 72c N J UCCNM AO mJWMlUN Of LOM- M64TAAA 2 0.K *<CM0 SS-gf 74* Taut Of 74k. O.TY'AM) Mown f*0NQW0 MAO 4:20 A OATE: 5/5/89 HOUR: Cdfnpfftk kNM 2Sc-dor>V--newotflrNritgpayer* 2V IOMIU1W>rrUWliOSLOUTMOCCUMU4tNiltUlt.MruUlM)OnO Cun M AOT MMalfNlA. ( |UTM H MIA M CkfTltr VCNATVMOf mONOUNCdt IMMEDIATE CAUSE (Fiftkl diwiM Of condition fkiurt* if*p in di(h). Sequentially till condition*. H any, lead- tap to <nwndi9i cause. 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'T 1 KlVtrtVlfcW MtUICALUsN Ifcrt DE. ?TMENT OF PATHOLOGY POST MORTEM EXAMINATION ftA-3382-89;___________________________________ DATE M*y S r IQfig--------------------ER IMF Colbv, Lawrence A.. AGE__SEX-____________________________HOSPITAL NO. 6901,0956 VTE OF ADMISSION. 5-5-89 :: . \TF np nFATH S''*5-5-89^ ^ HOUR HOUR 4:20 A.M. 4:36 A.M. iTE OF AUTOPSY 5-5-89 HOUR .. 11:30 A.M. -STRICTION: NONB -INICAL DIAGNOSIS: )CTOR ATTENDING: Dr> cheslock/Dr. Fitzgerald ^ATOMICAL DIAGNOSIS: I II, III. IV. FINAL ANATOMIC DIAGNOSIS Scar__adenocarcinoma of lung: involving: Liyer (Hepatomegaly 3400gm.) P1otL_ hi jataral Smail_bowel, lymph nodes (peri-pancreatic and mediastinal), microscopically adrenal (left) Splenomegaly(300gm.i with marked softening of parenchyma, consistent with sepsis. A. Left acute pyolonephritis and pyonephrosis with approximately 50ml purulent material in left pyeloureteral system. B. Bilateral renal congestion A. Bilateral pulmonary congestion (right lung, 600gm., left lung, 550 gm.) and underlying emphysematous changes, bilateral: Bilateral pleural antnracosis. R/O pneumonia. B. Bronchiectasis, left lower lobe. Atherosclerotic cardiovascular disease with: A. Cardiomegaly (420gm.), mild. B. Coronary artery disease, lad,right circumflex with approximately.S0-60% ; stenosis C. Atherometa subrenal aorta with extension to iliac arteries VMG/mm Vito M. Gulli M.D. PWOTOCOU OY M.D. PATHOCGGiST 26 UCC 075843 382-89 -1- COLBY, LAWRENCE A. A well developed, cachectic, white male measures 5'I1H and is estimated to weigh 125-1301bs. There is a normal male alopecia pattern as well as normal external male genitalia. The iridis are grey, the sclera show no icterus and the pupils are equal at 0.5cm. Upper and lower dentures are present and are complete. There are no palpable masses in the axillary, inguinal, cervical or olecranon regions. The abdomen is scaphoid and there appears to be an increased anteroposterior thoracic diameter. The umbilicus is midliQg* and there is a left inferior parascapular decubitus type .ulceration which measures approximately 4em. diameter. Mild peripheral cyanosis and m ild rigor and livor mortis are noted. A urine catheter is in place. INTERNAL GROSS DESCRIPTION: SEROUS CAVITIES: The thorax shows no fluid accumulations. Pericardium shows no fluid accumulations. a Peritoneum contains approximately 150ml of amber fluid. CARDIOVASCULAR SYSTEM: The heart weighs 420gms. The coronaries arise and distribute normally and, on serial secitoning, reveal moderate atheromatous plaquing in both the left anterior descending as well as the right tributaries, with the lumenal stenosis ranging from 50-60%. The left ventricular wall measures 2.0cm. and the right ventricular wall measures 0.3cm. The valves are well formed and show* no significant abnormalities or vegetations. The aorta and all of its major branches show mild atheromatous plaquing, particularly prominent in the abdominal segment, however, no thrombi or aneurysmal changes are noted. The major venous tributaries show no thrombi and no significant other abnormalities. RESPIRATORY SYSTEM: The laryngeal and tracheal structures are midline and grossly normal appearing. The right lung weighs 600gms. and the left lung weighs 550gms. Both pleurae show geographic anthracosis of varying degree. Close examination of both the pleural surfaces reveal indurated nodularities which range from sand grain size to approximately 0.5cm. in maximum single dimension and are found in apical as well as non-apical locations. On sectioning, the lung parenchyma is congested and there is some fluid expressed from the lungs upon compression. There is some interstitial fibrosis and grossly appreciable emphysematous type changes. In the left lower lobe, in addition, there is a segmental bronchial structure which is wide and shows thin walls and is consistent with an isolated bronchiectatic change. UCC 075844 .382-89 / -2- COLBY, LAWRENCE A. GASTROINTESTINAL SYSTEM; The esophagus is grossly normal and continuous with a stomach which shows a hyperemic mucosa. Although the duodenal, ileal and jejunum mucosae are grossly unremarkable but hyperemic, there are-multiple grey-white, indurated nodularities present in the peri-intestinal adipose tissue. These measure up to 1.5cm. in maximum single dimension. The large bowel shows no significant abnormalities throughout its course. In addition, some early autolytic changes are noted throughout. The liver weighs ^3,-4-QUgms, and sectioning reveals multiple multifocally confluent tumor nodules which measures up to 8cm. maximum single dimension. The intervening hepatic parenchyma suggests changes consistent with chronic passive'congestion and is minimally green tinged in some areas. The pancreas is located in a normal anatomic position, shows no gross evidence of distortion by either tumor masses or other pathologic processes. There is patchy fibrosis as well as some early autolytic changes to the otherwise grossly normal appearing organ. UROGENITAL SYSTEM: The right kidney is exposed following the removal of the perirenal capsule which strips easily. The right kidney, itself, shows a finely granular and congested exterior and weighs 210gms. Cortical medullary junction is grossly unremarkable and the medulla showed no significant abnormalities. The right pyelocalceal system is grossly unremarkable and courses into the bladder in a normal fashion. The left kidney is exposed following the removal of left perirenal capsule which strips with a little bit more difficulty. The left kidney, itself, weighs 300gms. and the cortical surface is hyperemic and patchy yellow-tan. Serial sectioning reveals the presence of disseminated, probable microabscess formation, with areas of confluent parenchymal dissolution. The pyelocalceal tract contains approximately 50ml of purulent material and some of this extends into the proximal uretheral tract. There is mildly associated dilitation of the calyces. The_ urinary .bladder is trabeculated and patchily hyperemic. The prostate measures up to 4.5cm., is symmetric, rubbery, tan-grey, and grossly shows no evidence of tumor nodule formation. The testes are grossly normal appearing with intact tunica albuginea and tan, seminiferous tubules which show residual elasticity. ENDOCRINE SYSTEM: Both right and left adrenals are mildly autolyzed with the left showing focal nodularity of the cortex which measures up to 0.3cm. HEMOLYMPHATIC SYSTEM: The spleen weighs 300gms. and the parenchyma is markedly defluent and congested. C* UCC 075845 , 3382-89 -3- COLBY, LAWRENCE A. Lymph node regions, including mesenteric, perithoracic, aorta and peripancreatic shows matted nodes which measures up to 3-4cm. in maximum sigle dimension, are grey-white and show focal necrosis. Similar nodules which may not-represent lymphoid tissue are adherent in several segments of the small intestine exteriorly. ' ** MUSCULOSKELETAL SYSTEM: Gross examination does not reveal any major abnormalities of the skeletal system. CENTRAL NERVOUS SYSTEM: The brain is surrounded by intact dura, upon the removal of which, a symmetric,, slightly edematous and congested brain is observed. The weight of the brain is l,350gms. and exteriorly, there are no areas of increased softening or purulent accumulations beneath the pia-arachnoid. The Circle of Willis vessels are intact symmetric and show focal nonocclusive atheromatous plaguing.. VMG/ce < ucc 075846 Re: Colby v.Union Carb_ e HISTORY: Lawrence A. Colby, was born on October 21, 1933 and died on May 5, 1989 at age 55 from primary adenocarcinoma of the lung which metastasize to the liver, small bowel and lymph nodes. He left surviving the following family: Phyllis A. Colby born July 24,1932 - his wife - who was 57 years of age at the time of her husband's death. Mrs. Colby works for the Middletown Housing Authority as a hous ing technician and earns approximately $25,000 per year. Lawrence - born August 17, 1959 - his son - who was 29 years of age at the time of his father's death and who is agoraphobic and was dependent upon his father for medical and paternal support. Since that time his mother has had to assume these responsibili ties. Michael - born May 25, 1962 - his son - who was 27 years of age at the time of his father's death - he is married at the present time. Monica - born June 25, 1966 - his daughter - who was 23 years of age at the time of her father's death. Between the ages of 19 and 23 she was dependent upon her father for financial support for her education? room and board and spending money. Lawrence Colby attended St. Aloysius High School in Jersey City where he graduated in 1952. He attended Gonzaga University in Spokane for 1 1/2 years during the time he served with the U.S. Air force as a flight attendant and flight mechanic and became a group trainer. He was honorably discharged in 1956. He also attended Seton Hall University for one year in the evenings and further had a Real Estate License for 4 years and worked weekends when he could. He resided in Jersey City for a total of 19 years. He then moved to Bayonne where he resided for 10 years and then to Belford until his date of death. His last address was 502 Mackey Ave., Belford, N.J. 07718. He married Phyllis Calabrese on September 13, 1958 at St. Paul's Church in Jersey city. UCC 075847 Work record: Mr. Colby has been working since he was 17 years of age except for his stay in the service. < Bendix Company in Mew Jersey - one year as a mechanic Jersey City Incinerator for 1 1/2 years operating an overhead crane. Union Carbide - OTD Worked out of Local 825, Operating Engineers, local that represented OTD. This was the same After he left OTD at the request of his wife since she felt the job was dangerous and affecting his health. He worked at various jobs through the Local. During 1988 he worked a full year and stopped working on January 3, 1989 and was hospitalized off and on until the date of his death on May 5, 1989. Mr. Colby earned approximately $45,000 per year which included full Medical benefits; a Retirement plan; he received the sum of $2000 asa bonus every November in lieu of vacations. Mr. Colby had intentions on working until age 65. At OTD Lawrence Colby worked as a Supervisor and Shop Steward on the assembly line in the Packaging Department and Assembly De partment. He was exposed during this period of time to polyethe lenes. and PVC pellets and powder. The concentrations of" these chemicals were heavy because of the intensity and density of the PVC--product and its monomer which made it very difficult to breath. He told his wife that bags would constantly break open and the contents would spill out. He even attempted to glue the bags to prevent them from breaking open. Mr. Colby worked with/thi> following chemicals: Polyvinylchlo ride (PVC^j and Vin^l Chloride Monojyers Polyurethane? Polystyrene; Isopropilfdene; Phenols; equipment lubricants and fuels? sealers in the vinyl resin bag packing bay. Union Carbide Corporation logo. (VCM); ^polyethylene ? Bisphehol Resins and fumes from the heat They all carried the * These products came into the plant in box cars in large bags of 50 pounds each and in 500 pound boxes. The bulk came in large metal containers carrying approximately 4050 thousand pounds which would be picked up in the air and dumped into a hopper which in turn went into the dumping room. This also carried the Union Carbide logo. There were no instructions or descriptions supplied for the handling of these products. XJCC 075848 During the period of time he worked for OTD he constantly com plained to his wife about the problems which existed at the plant and his exposure to the dirt and products that were packaged and referred to as PVC. The plant had no ventilation and the working conditions were bad. He would come home with white dust over his clothing which he would removed before entering the house and which Mrs. Colby would take to a laundromat. She would not wash his clothing at home. She would redo his underwear and socks to make sure that the clothing next to his skin would be absolutely clean because of skin irritation. He would constantly spit up white mucous and his nose, eyes and ears were irritated constantly. His nose would bleed on many occasions. His skin would constantly be irritated. The white powder irritated his feet and face which would get red. Mrs. Colby would treat his skin with an A & D ointment to relieve the irritation. He further suffered stomach pains, pain and weakness in both legs and difficulty breathing. Mrs. Colby often talked to other employees' wives at affairs they would attend about the conditions at the plant and they too would agree that they were having the same problems. Mr. Colby was seen by Dr. Rowland Goodman on July 29, 1986 and January 9, 1990. He was admitted to the Riverview Hospital on April 5, 1981; July 10, 1983; February 1, 1989 and March 7, 1989. He was admitted to Sloan Kettering in March of 1989. He was treated by Drs. Richard Commentucci, Luria, and Boyle as well as all the doctors and nurses listed in the hospital records. His medical bills were paid through his Local and Mrs. Colby's insurance company. His funeral bill amounted to $4,662.07 Mr. Colby worked helping his wife in and around the house, did all the painting, carpentry, plumbing and small repairs, did all the yard work and took care of all the finances. He did some auto maintenance work. He helped support his son, Lawrence, who is agoraphobic, with his medical bills in the approximately sum of $387 per month and assisted him in coping with this problem since age 16. He further financially supported his daughter, Monica, with her education. UCC 075849 Mrs. Colby receives pension benefits of $495 per month which began after the date of his death. She further receives the sum of $300 a month for life insurance which will end in 1994. Mr. Colby's son was seen by Dr. Furey Lerro of Red Bank, a psy chiatrist for about one year during and after his death at the cost of $125 per hour. Monica also was under psychiatric care for approximately 1 year after the death of her father and Mrs. Colby has been under the care of Dr. Susan Rhee for a period of 5 years at the rate of $125 per hour. These costs are only par tially covered by her medical plan. UCC 075850