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FILE NAME: Gardner Denver (GD) DATE: 1949 DOC#: GD010 DOCUMENT DESCRIPTION: Conference Report from the First Rocky Mountain Conference in Industrial Health t L`A u PASCAL I P101230804007 \ Dep... Mod...... Har,.....S e c Snell Tray Mem p 1 01 23 08 04 007 FIRST :ROOICf MOUMMN COHFEMCE IH ITOUSTRM, HEALTH Denver Chamber of-Commerce Building October 31, November 1 and 2 Denver, Colorado L '* First Annual Conference DENISON !/EMOR.AL LIBRA RY tame riders on, R. C. -very, Charles B. -eardmore, George W. ] ecker, G. T. lenesh, Lewis C., M.D. Irannaman, Ray H. I reman, M. I ridges, Clark D. 1 ridwell, 0. F. B igdanovitz, Robert C lurch, Franklin W. C ittrell, j. D. C niter, William J. D; nish, A. A. Di vis, Richard M. Dcyle, Henry N. Dcrsey, William A., M.D. Dirbin, Edgar, M.D. Ettenson, I. Z. Ev ms, Arthur W., M.D. attendance roster ADDRESS " Industrial Commission of Colorado, 768 Capitol Annex, Denver. Shwayder Brothers, Inc., 1050 So. Broadway, Denver. Potlatch Forests, Inc., Lewiston, Idaho. Stearns-Roger Mfg. Co., I720 California, Denver. United Airlines, Denver. Colorado Industrial Commission, Denver. U.S. Vanadium Corp., Grand Junction, Colorado. Zurich General Accident & Liability Ins. Co., Ltd., Chicago, Illinois. Colorado & New Mexico Coal Operators Assn., Denver. ' Assistant District Attorney^ C* A- Johnson Bldg, y Denver* University of Colorado Medical Center, k200 E. 9th Ave., Denver. Merchants Biscuit Co., 8k2 Walnut, Denver, Climax Molybdenum Co., Midland Savings Bldg. ' Denver, ; Julius Hyman & Company, Denver. First National Bank Building, Denver. U. S. Public Health Service, Box 2537, Ft. Douglas Station, Salt Lake City, Utah. United Mine Workers Assn., 110 Medical'Center, ' Colfax and Garfield, Denver. 1809 E. 18th Avenue, Denver. Kilpatrick Baking Co., 753 Santa Fe Drive, Denver. Colorado Fuel & Iron Corp. Clinic, Pueblo, Colorado. RAMB Fritts, George B. Gee, Addison H. George, Raymond A. Glaeser, Oscar A. jlanville, Leo ^ Proves, C. H. 1 roldsworth, Earl E. fallen, George S. reiser, Victor G., M.D <acobson, J. R. <:ensen, Frode, M.D. Jmes, W. E. Kihoe, Robert A., M.D. K ngsley, w. H. I K ttell, L. H. K] uger, Ada, R.R. Lfpx, Angelo, M.D. Le J.er, B. E. Lcli, Martin Le if, c. W. Mo ilvray, William A. -2- ADDRESS a 'HS0u PL f e r * n t e r l T Health' 204 CustTM Colo. Central Power Co., Englewood, Colorado. Gardner-Denver Co., 172 7 E. 39th Ave., Denver. ? e^ nins & MininS Co., Rewhouse Bldg., Salt Lake Cixy 13, Utah. Climax Molybdenum Co., Climax, Colorado. Colo. Fuel & iron Corp., Pueblo, Colorado. Gates Rubber Co., 999 So. Broadway, Denver. State Compensation Insurance Fund, Denver. Rational Assn, of Manufacturers, 14 w. 49th New York 2 0 , R. Y. b L *> Kilpatrick Baking Co., 753 Santa Fe Drive, Denver. ' University of Colorado Medical Center, 4200 E 9th Ave., Denver. * Climax Molybdenum Co., Climax, Colorado. Kettering Laboratory of Applied Physiology Cincinnati, Ohio. ` Sandia Laboratory, Albuquerque, New Mexico. Manufacturers Assn, of Colorado, Colorado Rational Bank Building, Denver. United Mine Workers Assn., 110 Medical Center, Colfax and Garfield, Denver. Denver General Hospital, Denver. University of Colorado, Boulder, Colorado. Monolith Portland Cement, Laramie, Wyoming. Idaho_Self-Insurers Assn., Carssow Building, Lewioton, Idaho. University of Colorado Medical Center, 4200 E. 9th Ave., Denver. ' * ]AME 1 cPeek, J. C. i iner, C. G. i oodie, John lorthcutt, Forrest E. C'Kane, Leo D., M.D. illmer, Charles P-nto, ShermanS., M.D. P 'terson, Carl M., M.D. P inci, Frank, M.D. P< gliano, Felix R: chards, Lynn S. Ri chards, Paul, M.D. RcDerts, Major David TRi idell, Stanley K. Ru it, Harold H. Ry m, James J. Sa ipson, Edward A. < Sc .ulte, Harry F. Sh< pard, R . T . v Spi rbeck, George W . , M.D. -3- ADDRESS U. S. Vanadium Corp., Rifle, Colorado. Colo. Central Power Co., Englewood, Colorado. Homestake Mining Co., Lead, South Dakota. First National Bank Building, Denver. Federal Employers Health Service, Denver. Standard Oil Company of Indiana, P.0. Box 1320 Denver. ' American Smelting & Refining Co., First National Bank Building, Denver. American Medical Association, 535 N. Dearborn St., Chicago, Illinois. University of Colorado Medical Center, 4200 E. 9th A v e ,, Denver. State Compensation Insurance Fund, Denver. Utah Self-Insurers* Association, 716 Newhouse Bldg., Salt Lake City 13, Utah. U. S. Smelting, Refining & Mining Co., Newhouse Bldg., Salt Lake City 13, Utah. Colorado School of Mines, Golden, Colorado. ' Industrial Commission of Colorado, 768 Capitol Annex, Denver. Colo. Central Power Co., Englewood, Colorado. American Smelting & Refining Co., First National Bank Bldg., Denver. ' Colorado State Chamber of Commerce, Chamber of Commerce Building, Denver. Los Alamos Scientific Laboratory, P. (). Box 1663, Los Alamos, New Mexico. Denver Fire Clay Co., P. 0 . Box 5510, Denver. University of Colorado Medical Center, 4200 E. 9th Ave., Denver. NAME Stearns, Robert L. Stewart, Allen F . , M.D. Thompson, G. M. True, J. M. Turner, Robert, M.D. Waller, H. E. Walmer, C. Richard, M.D. Waters, Theodore C, Weers, Arthur F. White, R. S. Williams, Joe T. Williams, Winifred S. Wolf, W. ADDRESS University of Colorado, Boulder, Colorado. Texas State Medical Association, Lubbock, Texai Employers Mutual Insurance Co., Equitable Bldg Denver. Mountain States Employers Council, 303 Boston Bldg., Denver. Roslyn Hotel, Denver. Armco Drainage & Metal Products, 3033 Blake, Denver. Industrial Hygiene Foundation, ^00 5th Ave., Pittsburgh 13, Pennsylvania. Industrial Hygiene Foundation, Pittsburgh 1 3 , Pennsylvania. 5th Ave., Weers Electric Plant Service, II50 Jackson, Denver. Climax Molybdenum Company, Climax, Colorado. Bunker Hill Mining Co., Kellogg, Idaho. Emily Griffith Opportunity School, 13th & Welton, Denver. University of Colorado, Boulder, Colorado. INDEX Me rning: Monday, October 31, 1949 Page Address of Welcome ........................................ Robert L. Stearns, President, University of Colorado * * "Management's View of Industrial Hygiene" ......................... William J. Coulter, Executive Vice-President in charge of Operations, Climax Molybdenum Co., Denver, Colorado. 1- 4 4- 9 The Need for an Industrial Health Program in Modern Industry" . . Victor G. Heiser, M.D., Medical Director, National Association of Manufacturers, New York City. 9-14 'Occupational Diseases of Executives" ............................. Robert A. Kehoe, M.D., Medical Director, Kettering Laboratory of Applied Physiology, Cincinnati, Ohio. 14 - 19 )pen D i s c u s s i o n ......................... .................... Af ;ernoon: 20 - 24 'Legislation and Judicial Trends in Utah as they Affect Occupational Disease Compensation" . . . . . . . . . Lynn S. Richards, Secretary and General Counsel, Utah Insurers ' Association, Salt Lake City, Utah. .......... Self 1_ 7 lift j'ff . Compensation for Partial Disability in Silicosis" ............... Oscar A. Glaeser, Industrial Relations Manager, United States Smelting and Mining Company, Salt Lake City, Utah. 8 - 13 Industrial Hygiene Codes and Their Impact upon Manufacturing O p e r a t i o n s ....................... ............................... Theodore C. Waters, General Counsel, Industrial Hygiene " Foundation, Pittsburgh, Pennsylvania. Compensation Law Trends in Colorado" ............................. Richard M. Davis, Attorney at Law, Denver, Colorado. 13 - 18 18-23 (pen Discussion ................... ................................. ?3 - 33 * * Tuesday, November 1 , 1949 Mo] ning: t 'The Selection and Placement of Workers" .......................... Clark D. Bridges, Director, Conservation Services, Zurich General Accident and Liability Insurance Company, Ltd., Chicago,^Illinois. t 1_ t M< rning: Tuesday, November 1 , 1949 "Experiences of a Mine Personnel Department" ............... Ernest W. Jones, Personnel Director, Climax Molybdenum Co., Climax, Colorado. "Does Maintaining Employee Health Pay D i v i d e n d s ? " ............... Charles Palmer, Assistant Personnel Manager, Standard Oil Company, Denver, Colorado. Open Discussion .............................. .. Ai ternoon: "Industrial Hygiene Engineering" . . . ................. . . . . . Franklin W. Church, Chief, Section of Industrial Hygiene and Toxicology, University of Colorado Medical Center, Denver, Colorado. Common Solvents Employed in Industry: Their Hazards and Control" Harry F. Schulte, Occupational Hygiene Engineer, Los Alamos Scientific Laboratory, Los Alamos, New Mexico. 'Industrial Hygiene in Industrial Relations" . . . . . . . . . . . Frank Princi, M.D., Director, Division of Industrial Medicine, University of Colorado Medical Center, Denver, Colorado. )pen D i s c u s s i o n ............ .. .................................. Page 4- 8 8-14 Ik - 2"J 1- 5 6-10 11 - ll+ 14-22 Mo 'ning: Wednesday, November 2 , 194-9 `What Industry Expects from the D o c t o r " ......................... Victor G. Heiser, M.D., New York City, New York. 'The Scope and Aims of Industrial Medicine" Robert A. Kehoe, M.D., Cincinnati, Ohio. ..................... Medical Administration in Industry" ............................. C. Richard Walmer, M.D., Medical Director, Industrial Hygiene Foundation, Pittsburgh, Pennsylvania. Industrial Medicine - A Specialty" ................... . . . . . Frode Jensen, M.D., Director, Graduate and Postgraduate Medical Education, University of Colorado School of Medicine, Denver, Colorado. pen D i s c u s s i o n .................................................. 2- 4 4-11 11 - 17 17-22 26 - 31 FOREWORD The first! Rocky Mountain Conference on Industrial Health was organized for t] e purpose of bringing together the various representatives of management and t] s medical profession for a discussion of mutual problems which concern workers ii industry. Since management, safety engineers, attorneys, physicians and per- sc m e l managers are all interested in the prevention of occupational diseases ar i m the maintenance of employee health, it is well that these groups meet to- ge :her occasionally to discuss the existing problems and methods of solving them, It is felt that the continuation of such conferences in this region will assure be .ter understanding by employer and employee alike of the many health hazards wb -ch are found in our present day industrial civilization. From such better ' un Lerstandings, improved working conditions and higher morale will result. This conference has been divided into five sessions, each of which was di ected toward a particular group, but any of which should have appealed to all th Se attending the conference. In addition to a small local group of speakers, a : umber of experts from other parts of the country were invited to speak, and thi se men gave unstintingly of their time, energy and enthusiasm and were most ini trumental in making the conference a success. The sponsoring organizations express their deep and sincere appreciation f02 the work undertaken by these men in preparing papers for presentation and f02 ohe enthusiastic manner in which the discussions were conducted. T Monday P.M., October 3 1 , I9J+9 Moderator: Dr. Robert A. Kehoe. Speakers: Lynn S. Richards., Secretary & General Counsel, Utah Self-Insurers' Assn.., Salt Lake City, Utah. Oscar A. Glaeser, Industrial Relations Manager, United States Smelting & Mining Co., Salt Lake City, Utah. Theodore C. Waters, General Counsel, Industrial Hygiene Foundation, Pittsburgh, Pennsylvania. Richard M. Davis, Attorney at Law, Denver, Colorado. Moderator: Ladies and gentlemen: Over a period of some years I have been placed in the position of answering questions presented to me by legal gentlemen, sometimes under awkward circumstances, so I am rather pleased this afternoon ^0 have, so to speak, the whip hand in a matter of this sort and I would lik oo urge the group here that when the opportunity comes we play them with the same kind of questions that they sometimes put to us. This particular sub ject of industrial health would certainly be quite unrealistic in terms of present day activities if we did not have these matters discussed in their legal aspects. I think one can scarcely escape the feeling that in our time mucn of the intention that has been centered on the problem of industrial healbh has been brought about, number one, because of the economic conse quences; this, that and the other occupational situation; number two, becauoe of the legislative activities which I think have been expression of th< increasing consciousness of the community as a whole in the need for legis lative control ^of one kind or another. I think that we are to be very much congratulated m having with us this afternoon four gentlemen who can speak to us very effectively on the subject. It gives me considerable pleasure to n roduce Mr. Lynn Ricnards, Secretary and General Counsel of the Utah Self Insurers Association, who will speak on Legislation and Judicial Trends in Utah as they Affect Occupational Disease Compensation. Mr. Richards. Mr. Richards: Ladies and gentlemen, it is with great pleasure that we come over on tnis side of bhe Rockies to associate with you in this conference. You !fe i. oe congratulated on attempting the organization of such matters as n-',Un,^aT"-n ne aere` ^7 ^ea--Lly came over I presume, as was suggested by one and agues, to find out if we are conducting our industrial hygiene t / nl 1 medlclne m the proper manner. We are glad to be with you and to associate m any way we can in your endeavors. In order to present to you an orderly picture of the development, general course and direction of occupational disease legislation and judicial ln u^ h > it wil1 te necessary to review in brief the history of the occupational disease disability law of that state. Utah enacted a Workmen's Compensation Law in I917.1 The definition of an injury was limited to accidental injuries. It has never been accepted by 1 . Compiled Laws of Utah 1917, Sec. 3O6I et seq -2- pensated^under^it^^"^11^ CCUpational diseases although some have been com- The enactment of the Utah Occupational Disease Disability Act in loin was preceded by a legislative appropriation, with authority of the Industrial TZf|!neq lrf:Gtor of the State to collaborate with the United States Public thP q-QferI1Ce^ n 3 SUrV6y f the metal mines> smelters and coal mines of ff- + purpose oi` determining the incidents and exposure to harmful quantities of silicon dioxide dust. 2 The result of the survey was l L X o W ^ Part +the hysteria that usually develops upon proposal of a h i l .4. uld ?^Gate a liability upon industry for an accumulated dis t com" lttee, composed of representatives of industry, labor and w i ^ - h o u ^ r 1 prfeBSlon' then Proceeded to draft the law which was passed without dissenting vote in both houses of the legislature.3 u!J!U \ n0t r!Vi6W thS provisions the Act, but discuss them as they have and tta Sterne c" rt!nStrUe<1 ** ^ dCcisions f Industrial Commissio ^ v n i ^ iCial ^ judicial decisions which have proved of importance, disease disease S SUbJect f silicosis "hich 8 named as an occupatioia scnedule of diseases. Silicosis is defined as a "chronic ' ,f tde llmgs caused by the prolonged inhalation of silicon dioxide ^ '^ u Y Sma11 discrete nodules of fibrous tissue similarly and hi' a ^ tonfhut both lungs, causing a characteristic x-ray pattern, and bj, variable clinical manifestations."'1^ y ^ becameUe i + VaS +?lly T 0 thS Supreme Court* years after the act s i S c o s i f ^ Ve + was called npon to review an award involving llicosis. The court, m casting about in other state decisions for exper ience and_supporting definition of the disease chose a loose one which "where the26' 1CS1S as a disease which is prevalent among employees ! the air is permeated with minute particles of stone, quartz slate " 5 iUSt " hiCh 1S lm,aled t0 the detri"" t t i s h L glhds 2 d V faP mor? y P f i n c - No inhalations can cause the disease ^ .han silicon dioxide dust and the detriment to the lung must he ' si " ^ ed by Gffla11 dis^ e t e nodules of fibrous tissue stmUarly dis seminated throughout both lungs." y The legislature did not desire by this definition to prevent lust claims Upon the committee who drew the Act ,,as a renown Industrial Physiciar 2 d finding " sSiIosis! * * deflnitl" upon to warrant a 2. Public Health Bulletin Wo. 270. 3 * Laws of Utah 19^1 , Chap. Hl; p . 79. !. Section 1f2 -la-29 Utah Code Annotated 19^3, 5 . Uta-Carbon Coal Co. et al v. Industrial Com. et al, 102 Utah, 567. -3- satLfsSi'he S S nSt aCrUed llabillty `he Act provides that no compenoation shall oe paid m case of silicosis unless during the ten -ears im exposed L PharmfiSgnthetdSableSen^ the lnJured emP-loyee shall have been ? , armful quantities of silicon dioxide dust for a total period of been exposed^harmful3 ^ ^ that the emplo^ee ^st'also havd 1J I TM S V " e? e0tiye date of Act which was July l ^ a T ihe law also provides that the liability shall not be apportioned amona the former employers but shall be the responsibility of the S t Z l o b in morT more, X7 after | L t^ ' ,iker the effective Tdate loafSttheeXPA0cSted(dJ-ulyla1e,aIp9eUr)i.od of 60 ^" o ^ t h r a f c o n c e r S n r ^ H at ^ Ut f ^ application of these provisions! lems concerning silicosis have centered primarily around three prob- 1 . What constitutes harmful quantities of silicon dioxide dust? 2 . Is a right to compensation the employee's exclusive remedy? 3 . Should compensation be paid for so-called parial disability? produce!ZZlZZZ S f " cS^r^r"" Z " Z dat refused to foll" reports and surveys offered by the employer that the minimum amount of dust would have to be 5.0 million particles S r I m l f V Z TCr a Poriod of to induce s Z c Z Z Z ! t S 2,000 of- its employees examined, Its survey showed only one was found to ave silicosis among those who had no underground mining experience " The no! i z z Z f z a r z r the r r ea states p u b u c aeaith "W'h,.GPG dlG0o oQ-vi1yrith4a-at-\ jW,l,,,tih respect to miners in Utah,J no sil--icGQoSs1iSs Wmct,S 1f0-1nAXm1CsL fon; L T to dust was less than 6.0 million particles per cubic 0+ i ^Th emP loIer surveys conducted under U. S. Public Health Service standard procedure shoved "an absolute maximum exposure 0f \ m i l S o n par with ' waishted * o? 1 .2 6 s j & t s s K r m e as pro a ive and sufficient to support the award, the testimony of o. ^7 Section if2 -la-l3 (a) (3). I Uta-Carbon Coal Co. v. Industrial Commission, 104 Utah 567 ft . Konnecoct Copper Corporation v. Industrial Commission supra. -7- +dfiL t?at there be paid t0 the Divls*cn of Vocational Rehabilitation of e oa e Board of Education not to exceed $5 2 0 .0 0 for use in the rehabili-j tatierrand training of the employee, this rehabilitation to be under the rec^ion of the State Board of Education Division. Only under these con dixions will compensation be paid. Compensation is allowed at the rate of $25-00 a week for not to exceed 10 weeks during the time the employee is actively in training under the l'/ision of Renabilitation. At the termination of the training period, e employee is paid $12.50 a week until the compensation to which he is en l ^e is paid in full. In no event may this compensation exceed in any one case an aggregate of $3,000 and all payments so made shall be credited o he employer and deducted from any award which might ultimately be made snould the employee subsequently be totally and permanently disabled.20 y w j oi summary, it can readily be seen that the definition of "harmful quantities which would require scientific determination to provide com pensation to only those who are entitled to be helped has been by judicial Thoveea "T1 aV0lded* There is a resistance against placing upon the em ployee a burden of proof which may be difficult to meet. remertvS!?tr +d+n0t an electlve law Purport to have an exclusive ,, ^ tute to avoid common law suits, an explicit definition of exclusive remedy will deter vexatious law suits. whichCwilCr r i ant tuSre ShUld bG a Provision in the schedule of disease; H *. , 11 afeSuard against those injuries to health not specifically defined m the schedule. Degrees of disability less than total can also be the subject of claims requiring legislative treatment. _ e ! i p ! L admlni3tratiVe ^ d Judicfal decision can be expected when trained It" is u;poa e technical and scientific aspects of compensation, law w h e r e b v ^ S r s vel1.informod legislature to provide the statutory engineer iu nraanad pnysician m industrial medicine and the qualified matters U ria aygrene can de utilized effectively in compensation 2 0 . Section 4 2 -la-58 Laws of Utah I9I1.9. -OO- Moderator: I think all of us will agree that that's a very interesting and very clear presentation of some of the important problems in litigation and legislation in this field. It is, therefore, a considerable satisfaction to be able to introduce Mr. Glaeser, Industrial Relations Manager, United States Smelting and Mining Company of Salt Lake City, on the subject of Compensation for Partial Disability in Silicosis. This is a subject which certainly does require considerable ventilation. Mr. Glaeser. Mr, Glaeser: Ladies and gentlemen, you have just heard the title of the subject that was assigned to me by Dr. Princi. I don't mind telling you that for me that was somewhat of a challenge. I have changed that title a little bit since I have developed a somewhat personal aversion to the idea of ! partial disability when we talk about silicosis. I would like to call this with your permission, Doctor, Compensation for Lung Changes Due to the Inhalation of Silica Dust, if I may. Compensation for silicosis is, with some exceptions, generally still considexed payable only in those cases where men clearly can no longer work because of the debilitating effects of silicosis complicated with tubercu losis. That the requirement of total permanent disability as a condition of compensation should be challenged should probably have been foreseen. In those states where so-called occupational diseases are compensable by definition of "injury," the transition from compensating only for total permanent disability to cover compensation for so-called partial disability was simply made by administrative action. Such change was, however, barred! in states having a so-called scheduled law and where compensation for sili cosis was by statute limited to conditions of total permanent disability, ihe demand to recognize earlier stages of silicosis, for compensation pur poses, has resulted in legislative changes in some states. ITew York recognized the complexity of the problems relating to compensating for so-called partial disability in silicosis. It appropriated $5 0 ,0 0 0 .0 0 in 1947 and made it available to the Trudeau Foundation to cover an investi- gation of how the debilitating effects, if any, of early stages of silicosis can be measured. This study is still continuing. It has so far produced insufficient information for any new conclusions. The Utah Occupational Disease Disability Law was amended by the 19I19 legis lature to include for the first time compensation for so-called partial disability in silicosis. Ho claims were filed immediately after the ef fective date of the amendment. However, in August of this year and after cessation of practically all mining operations in one of Utah's mining dis- j tricts, l6 claims were filed. As Mr. Lynn Richards has pointed out, the law now provides for a panel of medical experts. The panel consists of one roentgenologist and 5 internists specializing in various fields of lung and heart disease. The Industrial Commission, most desirous that the amended law should be administered as properly as humanly possible, requested all members^ of the panel to participate in the examination of this group of claimants and their records. The applicants were x-rayed. Only stereo x-rays were taken. Electrocardiograms and other tests ouch as blood count, | sedimentation rate, sputum test, hematocrit, Kahn test, urine analysis and in some cases even a biopsy were made of each applicant. They were given a careful physical examination. Work histories and family medical histories -9- vere carefully recorded. When the information was all assembled and with complete data at hand., the panel examined and reviewed the case histories. Each applicant was carefully examined by one panel member. Thereafter all panel members discussed each case and arrived at conclusions. Of the 16 claims filed ^ were found to have silicosis with tuberculous infection. Inis means, of course, that these claimants under the law are presumed to be totally and permanently disabled and compensation is being awarded accordingly. The other 12 cases showed no evidence of silicosis and the applicants were so advised, With one exception they were further advised that ohey coaid return to their mine employment without fear of endangering tneir health so far as present findings are concerned. Their employers were also advised of the panel*s findings. In order that you may be able to appraise the character of the medical pane] reports I would like to read to you the report of one of the disabling caset and the report of a case determined to have no silicosis. Report of Medical Panel (A Silicosis Case-] Extent of permanent disability - lOOfo. Silicosis; early conglomerate, Sampson - Class 3, with infection, inactive moderately advanced tuberculosis, left upper lobe; and non-specific mixed infection (bronchitis). Fractured nose, residuals from I926. i Sinusitis, exact status undetermined. Nasal septum, deviation of, right, severe. ~ | Rhinitis, chronic, moderate. Arteriosclerosis, compatible with age. Defective hearing, p rceptive, hearing 0/0 right; 15/15 left. Bronchitis, chronic, catarrhal, generalized, non specific, moderate. Emphysema, generalized, chronic, mild. \ ` This case was considered to be compensable as a total permanent disability case due to silicosis with tuberculous infection. Report of Medical Panel (Case having no silicosis) Arteriosclerosis, coronary. Defective hearing, chronic, mild, bilateral. -10- Rhinitis, vasomotor type, chronic, moderate. Hemorrhoids, external, ulcerated, chronic, moderate. Pes planus, bilateral 2nd degree, non symptomatic. Cardiac disease (a) Arteriosclerosis (coronary sclerosis), old infarction. (b) Myocardial damage; old anterior infarction; hypertrophy; mitral valve damage (sclerosis); mitral regurge. (c) Myocardial insufficiency, arrhythmia, premature beats; possible anginal syndrome. (d) Functional capacity III. (e) Therapeutic Class D. Bronchitis, catarrhal type, chronic, moderate. Peritruncal accentuation (x-ray), Sampson classification (late Pi or early P2). This case was considered to have no silicosis and, therefore, not entitled! to compensation. The panel recommended against return to mine employment because of the heart conditions. The Industrial Commission is optimistic with respect to the incidence of silicosis in Utah as a totally disabling condition and silicosis as a partially disabling condition. Commissioner Otto Wiesley, who is the Administrator of the Workmen's Compensation Act of Utah and the Occupation; 1 Disease Disability Law, believes that the number of so-called partial disaoility cases will be negligible and that the incidence of silicosis in Utah, low from almost the very beginning, will not be a problem in the future. He states that immediately following the effective date (July 1 , 19^1 ) of the Utah Occupational Disease Disability Law the Industrial Com mission was faced with 20 claims. Thereafter the number of claims filed annually dropped off sharply to but one or two claims per year until this year when the 16 claims for partial disability were filed under the new amendments of the Occupational Disease Disability Law. Commissioner Wieslc has said further, and I quote, "We yet have to find a miner in Utah who ha: worked 'underground less than 15 years and who has signs of silicosis." Commissioner Wiesley has said further that men who have been examined so far and have been found to have some silicosis have worked at least 20 yeai in Utah mines. In fact, and I still quote Commissioner Wiesley, "Some recently examined mine employees have been underground since 1915 with no sign of silicosis." The establishment of silicosis as a compensable condition and the amendment 3 thereto, which now make so-called partial disability compensable, has spot lighted certain situations that deserve the considered attention of the be 3 -11- men in industry, in medicine and in the legal profession who concern them selves with workmen's compensation. Those of you wno have concerned yourselves with compensation matters over the years, I am sure, will agree that silicosis is not the scourge that it was once labelled in a news reel in 1935 by the then Secretary of Labor. In thac year and largely as the result of the Gauley Bridge Tunnel exper ience a mass hysteria spread among miners throughout the country with respect^to silicosis what at that time was likened to the black plague in early history. It rekindled a long standing fear of so-called "miners' con vhich must be dispelled if silicosis is to take its proper place among the many other human ills that are no longer considered of major importance Practically all of the l6 claims that I have previously referred to were filed by the individuals because at some time or other the claimants were told^that they had silicosis. When they were informed by the panel of specialists that thqy had no silicosis they were actually surprised and not^a little confused. For example, one man asked, "Couldn't I have just a little?" In general they tell the panel that their family physician had told them they had silicosis and that they "now don't know what to believe.' The Industrial Commission and the panel of specialists have tried to con vince these men that they have no silicosis, first, by thorough examination and comprehensive test permitting a determination of what is causing a feeling of ill health, second, by having the men examine their own chest x-rays and by pointing out to them by comparative x-rays what silicosis looxs like, and third, by attempting to convince them a special technique is necessary to find early silicosis and that it requires a stereo x-ray ^(they are shown the difference between stereo x-rays and flat films). This panel of medical men try in every way to convince the men that the thoroughness of their examinations, together with the facilities that were used to arrive at the panel's conclusions, leaves little room for error. oilicosis^is not a condition that can be diagnosed as simply as measles. The lung is made up basically of air sacs, blood vessels and lymphatics. Each of these three component parts is subject to its own particular and peculiar disorders, any one of which may produce shadows in an x-ray film that might mistakenly be considered to be silicotic in character. Based upon almost ten years of Utah administrative experience a summation of the minimum procedures voider which a diagnosis of silicosis should be made is briefly: Clinical findings, stereo x-rays of the chest using only ,e large Ik 17" films with adequate x-ray equipment, a thorough and comple i,e physical examination which should include a personal, occupational, residential and family history, diagnosticians to include internists and roentgenologists thoroughly experienced in this field. Wot one but many case histories^ support these conclusions. It should be realized that any diagnosis of silicosis will start a chain reaction which touches many people^and which persists regardless of the correctness of the diagnosis. Also, if incorrect, that it will do great harm to the man, that it will proDably mean serious financial loss, hardship to his family, and disloca tion of employment. A financial burden may be imposed upon"the state which may have to go through an expensive procedure to disprove an erroneous diagnosis, -12- As a case in point I would like to review briefly a recent experience con cerning a man thirty-two years of age who, at the time of his employment in a mine on July 8, 19*1-8 , had had no previous record of work in mines or in so-called dusty occupation. Recently he was absent from work for several weeks because he did not feel well. He had gone to his family doctor who told him he had silicosis. His employer suggested that he be examined by a specialist. The man agreed readily. The examination re vealed there was no sign of silicosis, that the man's chest x-ray taken at this examination was practically identical to that taken when he was employed 15 months earlier. The man was actually suffering from an allergy of hay fever- and bronchitis which first developed in 19*1-8 and then disap peared and came back in July of this year. Ten days prior to his last examination he had developed an infectious process in his bronchi, which condition was then subsiding. The examining physician so advised the patient. Despite assurance that he has no signs of even early silicosis this worker has asked to be transferred to surface employment. This man had an excellent work record. He is above average intelligence, is some what of a short story writer and has been seriously considered for promotio to a mine foreman. A typical example of how men may become imbued with the idea that they have silicosis is demonstrated by one of the group of 16 men recently examined by the Industrial Commission's medical panel. This man, at the onset of the investigation, showed a rather belligerent attitude toward the investi gation because he said he knew he had silicosis. He said his father died of "miners' con" and that his brother, who had also worked in the mines, was now in a hospital and totally and permanently disabled by reason of silicosis, and that since he had worked in the mine of the same area, there was no question about his having silicosis also. As a matter of fact, miis m a n 's brother, who has been examined carefully on several occasions, was known not to have silicosis. Furthermore, the man in question had on his own accord sent chest x-rays to a specialist who had already told him he did not have silicosis. Despite all of this information to the contrary he insists that he has silicosis. Now, as a matter of fact, he does not have silicosis, and the medical panel feels that it has quite a task on its hands to convince this man of that fact. *--*--*-c o s*-s > so-called, is a peculiar lung condition. It is not an infection; process, nor is it contagious. The most positive diagnostic procedure, the f reveals the protective mechanism which nature provides rather than the silica dust particles. This lung change generally cannot be clearly distinguished from other conditions in its early stages, but, becomes dis tinguishable in its intermediate and later stages before the'individual develops a physical awareness of any change.I I am of the opinion that there are probably many human ills which in their indistinguishable beginnings are hardly ever considered disabling to any degree, nor are such early signs labelled as a disease or with the name of a specific disease. I have in mind conditions such as sore throat, which may, in now rather rare cases, be the early indication of scarlet fever; athletic heart, which may in future years result in heart failure; a pig mented mole that might develop into cancer; or a back ache that might well be the indistinguishable beginning of a serious arthritic condition. On the -13- other hand, archest complaint or a barely discernable lung change is fre quently and without the benefit of a pathologist or roentgenologist diag nosed as silicosis. I have often wondered whether in cases of early lung changes we are not perhaps inclined to establish a "disease" in our minds long before it may be determined physically with any degree of certainty. America's outstanding worker in this field, Dr. U. LeRoy Gardner, after is many years of^intimate investigation of silicosis and diseases of the lung, strongly maintained to the very last that there is no such thing as partial disability in silicosis and that men id not become disabled as the result of simple silicosis. It would seem, therefore, that if compen sation is to be paid for a lung change that is not in itself disabling, tne basis of payment should not be labelled as "partial disability." The label should be - what in fact it is - payment for a non-disabling lung change.^ Such payment at this time appears justified only if the worker loses his^job and can find no other at comparable wages because of a lung ciange wnich is the direct result of his occupational environment. The misnomer partial disability" may be far more debilitating to the indi vidual than the^condition within his lungs. Ample evidence exists that in he large majority of cases silicosis is not disabling and does not prevent the worker from performing physical labor. If that is the case then the term partial disability" merely invites such a workman, his family and rlends to consider him a semi-invalid and suggests that he thereafter look to compensation rather than employment for maintenance. This situation, in my mind, raises this further question: Is it possible that we have fallen acceptinS a terminology merely because it happened to be . use ' we are confronted with a lung change that is neither a disease as the word "disease" is normally used and which svmptomatically tails to reveal any physical impairment or even discomfiture with physical degree?11' ^ ^ ^ ^ t0 acknovledSe a disability in any ;En conclusion may I say, that in Utah silicosis is not a problem and the indications are_that so-called "partial disability" by reason of inhalation 8adlca dust ls>not going to be a problem. The Utah medical panel plan is effective and m addition is doing an excellent public service which C0^ emP-|-a-bed. Only qualified men should presume to diagnose so- iTr, >,ear y sll^Gosis* There is to date no competent evidence that early' ^ung change due to the inhalation of silica dust is disabling in any degree. " s i l i ro^0-'3 ShUld SiVSn t0 present day terminology of "disease, silicoois and partial disability," when referring to lung changes that havre no, progressed to the point of clearly demonstrable disability. Moderator. Our next speaker, I believe, is known to most of vou and scarcely requires an introduction, since Mr. Theodore C. Waters, General Counsel of the Industrial Hygiene Foundation at Pittsburgh, has been working very vigorous y m this field for many years. It's a pleasure I'm sure to in oroduce him. He will speak on the subject Industrial Hygiene Codes and Their Impact upon Manufacturing Operations. Mr. Waters. Mr. Waters^ May I preface my remarks by reminding you of the purposes and liaj-.ruies resulting^in the enactment of workmen's compensation statutes, hese statutes provide benefits for those who sustain injuries, either -14- traumatic or resulting from occupational diseases arising out of and in the course of employment, without regard to any fault or negligence of the employer or employee. Under them the employer becomes an insurer of his employees against the injuries made compensable under the statute. The statute provides the exclusive remedy to the employee for injury so sustained with a limitation and monetary liability on the part of the employer. Such laws are now effective in all the States of the Union, and since their original enactment the tendency in this field of legis lation has been to increase the scope of the law to include all injuries, whether traumatic or sustained by occupational diseases, provided that the injury is peculiar to, and the result of, an industrial process to which the employee has been exposed. They have become of increasing im portance in the field of industrial relations. Employees have become in creasingly concerned with the subject of protection of their health, and employers have come to appreciate the fact that the cost of prevention of industrial injuries is but a small part of the cost of compensation for injuries so sustained. In other words, industry today has become health conscious, and with that consciousness there has developed a public demand that all industrial processes shall be conducted in safety with the eli mination of hazardous conditions that may give rise to industrial injuries. Directly related to the purpose of providing compensation for an injured employee is the purpose to control and prevent industrial injuries. In the past decade we have witnessed the extension of activities of Divisions of Industrial Hygiene to eliminate, insofar as it is possible, all indus trial hazards. This has resulted in the adoption of codes of industrial hygiene and the assignment of their enforcement to State Agencies, skilled and experienced in that field. Diseases are now compensable in forty States, the District of Columbia, and all of the territories of the United States. The form of these statutes differs; seventeen States-^- having adopted so-called schedule coverage laws, and twenty-three States2 having adopted so-called general coverage laws. There are now fifty-eight Industrial Hygiene units established in various 1 . Arizona, Arkansas, Colorado, Georgia, Idaho, Iowa, Kentucky, Maine, New Hampshire, New Mexico, North Carolina, Pennsylvania, South Dakota, Tennessee*, Texas and Virginia*. *An employer may elect general coverage. 2 . California, Connecticut, Florida, Illinois, Indiana, Massachusetts, Michigan, Minnesota, Missouri, Nebraska, Nevada, New Jersey, New York, North Dakota, Ohio, Oregon, Washington, Wisconsin, South Carolina. (United States: Civil Employees, Longshoremen's Act). Delaware, Rhode Island and Utah. -15- State and City Departments. 3 To these units have been assignee the dutv to supervise and regulate the eonduet of industrial p r o o e s s S in the TM r aidUriSeguuil^at^inonss1Citthaa?t I would like to dir"ec4t "you1r3 "atitthentrGiosnp.ect to' such The obligation for the prevention of industrial injuries rest- unnn both employer and employee. It is the obligation of tSe employerlo ?nstaU h protective equipment and furnish such appliances as iedical and r t r i S aiye-ietheri^ d u - tnal hygiene codes for the regulation of hazardous industrial prao?ices. The word code is defined in Bouvier's Law Dictionary as follows: "A body of law established by the legislative authority, and designed to regulate completely, so far as a statute nav the subject to which the statute relates." " ^ i e M lc o S r t r f o m r e i ^ f en^iCTM ent of industrial P - r t0 r - i - - " - - " i n j S ^ f f o ^ e a l t h , gTud^uqit-pfistoit a r n Fr ^T..f .i \r liir6* dH` Ad ' LBloSomfEieSld,15 ATssi"st-a"ntV "Chief of the industrial Hygiene Division of the IJ s it.-ijli n . npnjQn , _ . A ^ Healuh Service issi. Ssilhesfcodef" anfde^an^rr" " 1,111 n0t be possiile t0 dls- codes; namely, S Y Sl1' bUt Certain m t t a r s Peculiar to all (1) the administrative agency charged with the promulgation and enforcement of the code, b (2) maximum allowable concentrations of toxic substances, and (3 ) provisions dealing with sanitation, safety and housekeeping. 3 * As of October 1, I9I19. p -16- ADMINISTRATIVE AGENCY To the administrative agency is given the power of enforcement with a penally to he imposed, in the event of any violation. In practice the Divisions of Industrial Hygiene of several States have assumed an adminis trative policy of education and cooperation, rather than the exercise of police powers to restrain industry from violation. It is a tribute to the administrators of^these units that representatives of industry look with confidence on their activities, welcome their cooperation and assistance in solution of problems, and utilize the services of such Departments to he end that their operations may be conducted in full compliance with the legal requirements. Tne purposes of the administrative agencies have been to guide industry in he correction of practices that tend to create hazardous conditions, and xo assist industry in maintaining the health of employees. Industry seeks -e maximum production of its materials at minimum cost. If our competilve system is to be retained and business is to succeed, these bureaus must^assist m the attainment of that goal by the simplest and most inex pensive methods possible. In some States the administration of industrial hygiene codes may be grantee nre ?t a ! aeen cy ' f o r e*a"Ple , the State Department of Health, ohe State Department of Labor or the State Industrial Commission. This has lead to considerable misunderstanding and confusion on the part of indus- n e s seeking to comply with the rules and regulations established by severai Sta^e Departments. In a given instance the Health Department may mak recommendations or issue orders with respect to operating conditions; concurrently or shortly thereafter conflicting orders may be issued by the S-?har r nt ^ Lab?+ r thS ther DePartnent having authority in the matter, wixh the net result that the industry sought to be regulated mav not be aid tie r d i ^ r e n t requirements of the respective Departments and uxxe cause of industrial hygiene is retarded. It must be borne in mind that the problems presented to the Division of industrial S i ? 6 ^ health problems, involving the control of industrial conditions that may injure the health of exposed employees. In aL 0inni0n ^ Jollows that state Departments of Health are better equipped and organized to administer codes than any other State Agency. MAXIMUM allowable concentrations of toxic substances Sucn concentrations have legal status in approximately fifty per cent of one codes now effective; in the remaining codes they take the form of S n t i i t a XnS o r .susgested S l i d e s . Prior to the inclusion of such con- centratmons in a given code, it is submitted that a thorough study of plant , 1;dlJ 10nS thS State should he conducted to determine the potential practicable f P ' ^ t0 ascertain A e t h e r or not it is reasonable and Z Z l l t l t f t gT n industr^ t0 coPly with the proposed maximum. auo of Industrial Hygiene should desire a reasonable and practicable code in the same manner that industry does. Further, with respect to such permissible concentrations, it is submitted that it is unfair and unreason- aole for one given sample to be taken and serve as the basis for an alleged -17- violation. In this respect, I am most critical of a number of the codes that are now effective, because they do not establish the technique to determine concentrations or provide some average atmospheric condition existing over a period of the shift during which employees would be working Fortunately, we have had sane administration of the codes, but it is highly probable that at the instance of pressure groups, industry may well be em barrassed oy violations of these permissible concentrations and the cause of industrial hygiene thereby retarded. It is further submitted that the proposed maximum allowable concentrations should be subject to annual re view, and the permissible limits adjusted in accordance with scientific research that may develop information as to what are proper standards. PROVISIONS DEALING WITH SANITATION, SAFETY AND HOUSEKEEPING Examination of the various codes will develop extensive differentials in the provisions applicable to these subjects. It is submitted that these rules and regulations should take the form of recommendations, rather than specific prohibition of given practices. The burden of compliance rests just as heavily upon the employee as upon the employer. The employer is dependent upon the discharge of the employee's duty to attain compliance. Modern industry seeks to operate clean plants and to maintain cleanliness and good housekeeping throughout those plants. This cannot be done without the full cooperation of the men who work on the job, and again management may be unable to enforce rules and regulations that Bureaus of Industrial Hygiene might consider proper. An important activity of Bureaus of Industrial Hygiene will be to assist management in educating employees in the proper discharge of their duties so that the requirements of the code with respect to these matters may be fulfilled. J Many of the codes require an employer to furnish personal protective equip ment in specified operations. The furnishing of such equipment does not always result in the prevention of accidents or injuries, for which their use^is designed. Upon the employee rests the duty to properly utilize such equipment and, in the event of his failure to use same, he should be penal ized in some way. It is practically impossible for the employer to police the^maintenance and use of such protective equipment. Accidents happen . that could have been prevented by their use, and, assuming that the employe: hao discharged his liability by furnishing the protective device, the em ployee should be required to use it. Effective penalty provisions enforcing use will materially assist in the administration of this phase of the code. The American Conference of Governmental Hygienists has had under consider ation for several years the draft of a uniform code which could be recom mended to the various State Agencies for adoption. That matter has been the subject of careful consideration by the Code Committee of the Conference The draft of the proposed code, as submitted to a recent meeting of the Conference, was circulated widely among various interests that would be affected by the proposed adoption and administration of such a code. -18- At the Spring meeting of the Conference action was taken to submit the draf to the American Standards Association for its criticism and advices. It is the ultimate purpose of the Conference to approve such a draft of code and to have it available for any State Agency that may desire to use it. For such procedure to be effective it would probably be necessary for several States to repeal legislation now effective upon this subject; and to enact new legislation granting to one State Department the power to regulate and control industrial hazards. CONCLUSION In my contact with various State Departments administering codes in the past; it has been my experience that their personnel are thoroughly alive to their public responsibility in the administration of codes. Generally speaking, they have been administered in the spirit of education and co operation; rather than by the enforcement of penalty provisions in the exercise of police powers. There are many hazards in industrial operations and industry has not; as yet, succeeded in attaining perfection in their control. While the cause of industrial hygiene has been promoted rapidly in the past decade, there is still room for improvement. Industry is seeking to discharge its obligation to protect the health and welfare of those engaged in our industrial processes. Bureaus of Industria Hygiene have an important part to play in accomplishing this result, and ir the administration of codes they have the opportunity to assist industry, and to minimize injuries resulting from improper industrial practices. Let us bear in mind that, when adopted, industry must live with these codes; that their successful administration will depend upon the degree of cooperation existing between industry and the personnel of the administra tive agency. The formal adoption of codes does not of itself put an end to hazardous conditions, and this can be accomplished only by intelligent administration, careful supervision and education. Moderator: We have heard three very interesting discussions on this subject. The greatest difficulty a chairman or moderator at this kind of meeting could possibly have is trying to restrain himself from not taking advantage of the great number of subjects to comment on. I shall hold myself in check and introduce the fourth speaker. I am sure that you will be very much interested in knowing the trends in compensation law in the State of Colorado just as I think all of us who hail from other states wish to be adequately clear on the trends in compensation laws in our respective state I am pleased to introduce Mr. Richard M. Davis, practicing attorney of Denver, who will speak on these trends in the State of Colorado. Mr. Davis Mr. Davis: I fear it may be all too evident before I 'm through that I'm an ama teur in a professional field up here, so I think I should apologize first and admit it. I am not a practitioner of Workmen's compensation exclusivel However, I do want to present to you, to you who are from Denver and from other points in Colorado and from out of state, some thinking from a strict legal standpoint, and perhaps from an overall policy standpoint, of a practicing lawyer on the subject of workmen's compensation and the current trends in that field, particularly in occupational diseases. -19- Strictly I should say that we have no particular current trend in Colorado with respect to workmen's compensation laws that varies from the national trend. In other words, our trend is upward as far as rate structure is concerned and the basic concepts are pretty well established in this field excluding occupational diseases. The last legislature amended the Colorad' workmen's compensation law, which had been amended prior to that in 19^7 > and rates established in Colorado which I think now need no apology. I believe that we are about the mean for the United States. We have an elective law in Colorado, not a compulsory one, except as far as public employees are concerned; we have insurance available in the state fund or in private insurance carriers or self insurance. We have normal coverage, I believe, excluding agricultural workers and domestic help, and we have a numerical exemption of four, which I think is rather typical. The measure of compensation is 50$> of "the average weekly wage; the maximum under our recent amendment for a weekly benefit is $22.75; the minimum is $10,00 a week, regardless of wage, an increase from $7.00 previously in ef fect. The maximum recovery in a fatal case is $7,098.00, not too much of an increase. The maximum recovery for permanent partial disability is $5 ;9 1 5 *0 0 > an increase from $^,500.50. For permanent total disability we have life-time compensation which puts us in the upper half or third of th< states of the United States and is something of which we can be proud. Medical and funeral compensation rates are: $1 ,0 0 0 .0 0 `and six months for medical benefits plus prosthetic devices, an increase from $k00 to $500; funeral expenses a flat $150, We have a waiting period of 7 days and a six weeks retroactive provision. We are also in line with many of the oth< states in having a subsequent injury fund which was established in 19^5, a: a means of enabling an employer to run the risk of hiring handicapped workers. Administration of Workmen's Compensation in Colorado is by the industrial commission and is compl te supervision over the process of com pensation, throughout. To compare Colorado with other states, I have used the U. S. Government summary of October, 19k8 , consequently my figures may be slightly out of date. On the question of the elective versus the compulsory type of statui (organized labor has been arguing for years for a compulsory statute) I find the national figures are about 50-5 0 There are about 28 states that have compulsory laws and 26 that have elective laws. Some laws are pre- , sumptive of acceptance in the absence of actual notice posted by the em ployer rejecting the benefits of the statute; this is the case in Colorado. Most of the states permit the use of private insurance companies and do not make compulsory the state compensation fund; I believe that there are only 7 stages that do so. Self insurance has a place in Colorado, but I am not going to comment on that at the moment.I I understand that on a national basis the workman's compensation laws prob ably cover only 50$ of the gainfully employed workers, due to the various exemptions from the statute's coverage. As I said before, Colorado is typical in that respect, in its exclusion of agricultural and domestics and less than four workers. I think 30 states have a numerical exemption of some kind, as does Colorado. I believe most of the states permit volun tary coverage as is available in Colorado if you want it. Colorado is one of 18 states, possibly 19, that has lifetime benefits for permanent total -20- disability and I believe all the other states have a limitation of the amount of dollars or the period of time. The new maximum death beliefit of $7 ,O98.OO puts Colorado in the upper half of the states but it is not,, as I'm sure you all know, anywhere near as high as some of the more highly developed states. Colorado, like most states, gives compensation for per manent partial disability in addition to total disability. It is very controversial, of course, this business of placing a limitation on medical expenses and medical benefits. A good many people feel that it is not sensible to have a limit as to amount or as to time on medical ex penses. I am advised, however, that that question has not arisen a great deal or been an embarrassment in Colorado. I am advised by both a repre sentative of the Commission and practitioners engaged in compensation work that it doesn't often happen that a carrier will deny liability or will invoke the statutory limits, either as to amount or as to time with respect to medical benefits. I therefore feel that the criticisms which used to exist as to the low com pensation rates prevailing in Colorado have been pretty effectively eli minated by the 19^-8 amendments of the law. We started compensation in this state in 1915 with a rate of $8.00 per week maximum; there has been a steady march upward and for many years the maximum rate was $1 4 .0 0 . In 19^7 j as I think I told you, it went up to $17-50 and it is now $22.75. Our act authorizes, as do many, the payment by the Commission, and at its discretion, of a lump sum benefits in lieu of weekly or other benefits. There is criticism by insurance carriers of this provision of the law and there is a tendency in some instances to abuse that privilege. To criti cize our law a little further, or evaluate it, we have in our statute (Section 7 7 ) a prima facie presumption of permanent total disability in the loss of any two limbs, two eyes, or any combination thereof; that's sup posed to be a prima facie presumption. Our Supreme Court has tended some what in the decided cases to consider this a conclusion presumption of total disability. There are those who believe that this is not a proper attitude; the loss of an eye and a limb is not necessarily a permanent total disability. I have discussed with attorneys who represent claimants and who represent , insurance carriers, the administration of the Colorado law and I think it is fair and reasonable to both sides. The actual detailed work of the commission, as in many states, is handled to a large extent by the referees, the ^Commission taking only official action. I think it's fair to say that ' io is the consensus of informed opinion here that the workmen's compensatior law in Colorado is well run, and that the Commission doesa very effective job of administering it and of supervising it. I am sure that probably any body who has had experience could cite some examples showing that I'm wrong in stating that, but I believe that's a fair appraisal, nevertheless. We have two or three anomalies in our law that should be eliminated; one of them is that we have a prima facie presumption that if death follows more than two years after an accident it is prima facie presumed not to be due to the injury, and then a statement following that, that if death resuits within two years, benefits will be paid. This has resulted in a -21- decision by our Supreme Court, which I feel must be corrected by legibo-ction, to the effect that whefe death occurred more than two years after injury there is no death benefit - whereas if the death occurs within two years after the injury but not as a result of the injury, you get death benefits. A bill to correct this anomalous situation has been introduced at least once and died in committee. Further criticisms of our law, particularly by the labor unions and claim ants, concern the provision which provides for a 50$ cut in compensation due to wilful failure by the employee to use safety devices, failure to obey reasonable safety rules, intoxication, etc. I do not think this is a legal problem because I can't imagine such a provision being improper. Some such measure should be in the law in this respect. The principal criticism is that this provision places on the employer the duty of es tablishing reasonable rules of safety and to have safety appliances and devices and in the absence of these there is always the question of whether the employer has met his obligation and whether the employee has fulfilled his by using them. The most interesting thing about Colorado Workmen's compensation law re lates, I believe, to occupational disease and to the trend in the direction which I would describe as to much a matter of theory and not enough actual factual basis for compensation awards. You all know that the courts are pretty well dedicated in all states to liberal interpretation and construction of workmen's compensation laws. That is a very reasonable proposition with which no one should argue. The acts should be construed in the light of their purpose, and their purpose is to give compensation for industrial injuries. We have come a long way, we already are a far cry from the common law basis of legal liability; where you say that an injury suffered as the result of an act in the scope of employment is the basis of legal liability for which there is insurance. This is particularly true when we come to occupational disease. The courts in Colorado have done the same thing as has been done in many other states, namely they have tried to stretch the content of the workmen's compensation law, deliberately I think, in many cases, to permit recovery where they thought the employee ought to have compensation, even though the letter of the law, the original scope, the strictly legal interpretation of liability was missing in one respect or another. Our occupational disease act in Colorado was passed in 19^6 and before describing it at all, I think it's fair to say that it is a highly restrictive type of legislation. It can be said here again that a fair evaluation of informed opinion would be that the occupational disease law in Colorado at the present time is close to ridiculous. The reason for that is quite clear; it is a schedule law, not a blanket law, and it names silicosis and asbestosis and nineteen different types of poisoning. Coverage applies to all employees who are subject to one workmen's compensation act and either the employer or employee may ac cept or reject it. The act purports to be the exclusive remedy in case both employer and em ployee are covered and, apropos of what was said earlier by the speakers on this program, I think that the provision in the lav denying the employee any remedy unless both are covered is of doubtful validity. The reason -22- that our law doesn't work (and we have practically no cases, we have had only a few cases that have ever reached the Supreme Court) in a practical sense is that it places an almost impossible burden of proof upon the plaintiff. The law requires the employee prove "by competent medical evidence," that there is a "direct causal connection" between the disease and the employment; that the disease was a "natural incident" of the work; that it can be "fairly traced" to the employment as the "proximate cause"; that it flowed from the source of employment as a "natural consequence." I don't think that any of you are naive enough not to realize that when the lawyers use language of this kind in a statute it becomes just a ques tion of words; it becomes necessary to prove what is meant when you say that an occupational disease must have a direct causal connection, must be a natural incident, and must be fairly traceable to the employment. In addition to the difficulties of proof we have definitions of silicosis and asbestosis that are very extreme. Silicosis refers to the disease caused by "uncombined silicon dioxide." Disability must be within two years of the last exposure; death must occur within two years of the last exposure; during the past ten years the person must have received his dis abilities and must have been exposed in harmful quantities. With respect to the poisons named in the law, disability must be within 120 days from the last exposure, death must have resulted in one year, claim must be filed within one year after disability, etc. Also defenses exist including willful misconduct, violation of safety rules, willful self-exposure with certain prescribed presumptions of will ful exposure in certain cases. I will not take the time to go into the benefits but they have not been brought up to the standards of workmen's compensation laws. We have in our statute another restrictive and con- flictive provision, Section 1 7 , which provides that where an occupational disease is both complicated with or aggravated by non-poisonous or other non-compensable disease, or vice versa, first the compensation is reduced to that portion of the disease which is attributable to the compensable disease, and if the cause can't be separated, there will be no compensation,! except that if disability or death occurs due to silicosis or asbestosis, | complicated by tuberculosis, then compensation is awarded on the basis of uncomplicated silicosis. ! To summarize, the difficulties of proof under our occupational disease j statute are terrific; the claimant often can't live that long or can't pay for or can't get the medical and other evidence necessary t.o prove his claim. Proof of this is found in the fact that the men who work in the ; field know, of their own knowledge, of cases where there was unquestioned ! silicosis, and where the insurer has acknowledged liability and paid bene fits, although the claimant was wholly unable to prove his case, due to the many restrictions of the law and the many difficulties of proof. . I will not take the time to summarize the provisions of other state laws or comparable laws. I believe that out of the I4-O odd states that have 1 occupational disease laws, about 23 have a schedule law like Colorado. , In 21 of the states I believe the benefits for silicosis and asbestosis are limited; i.e., they are smaller than they are for personal injuries , under the workmen's compensation law as in the case of Colorado, and -23 Colorado joins the lit- other states that have no recovery for partial dis ability. In 9 states according to the information I have, the medical care for asbestosis and silicosis is strictly limited as compared with other injuries, and that is true in Colorado. In conclusion, I would like to say, based on this brief review, that I am more interested in the work that has been going on at this conference and I think it's a splendid thing. It has interested me very greatly to study the occupational disease law and think about this business of industrial hygiene. I feel that from the point of view of legislation, from the point of view of a lawyer, we have a good deal to do if the current trend in the country is toward full coverage for occupational diseases. If industry is to be made legally responsible for death and disability due to occupational disease, I think it behooves industry, the experts here, and the medical profession to do certain things which to my knowledge have never been done adequately and which many of the speakers on this panel are engaged in doing; namely, we must thoroughly examine and define occupational disease; we don't need to define it' just in grammar, we need to define it in meaning and content* we must have objective standards for determining what it is and what causes it. There may be much room for argument, but there has to be some objective standard. Standards must be set if we are going to use them as the basis of legal liability. We should have, or develop by scientific means, criteria for measuring de grees of disability due to occupational disease. That is a tremendous challenge, but we should reject, in my opinion, any notion that industry has to pay the bill for health and accident insurance for all of its em ployees, for whatever reason. This is a different matter; one of social responsibility. If we are going to do that, let's do that as such; but as long as we proceed on the basis of insurance and as long as we go on the basis of legal liability and responsibility, we should steer away from any notion of pensions or retirement and stick to compensation on the basis of known standards, I think that's quite an order for anybody to ask for, but that's what I feel we should have and that's what I hope and believe that a conference of this kind will help develop. Moderator: I 'm sure that this has been a most instructive period of talks and I think that we should have an opportunity for further exploring the know- , ledge and information that these gentlemen can give us in an open dis cussion. DISCUSSION Moderator: Gentlemen, I think we can get to our questions. I have looked them over with the idea of sorting them out. The question is raised of Mr. Richards. Can you compare the relative cost of a partial coverage in relation to complete coverage of occupational disease laws?" Mr. Richards: I think that Mr. Glaeser can answer that better than I can. That's an operator's problem. Mr. Glaeser: First of all, I don't think that I quite understand the question. Wednesday A.M., November 2 , I9U9 Moderator; Mr. Oscar A. Glaeser. Speakers: Victor G. Heiser, M.D., New York City, New York. Robert A. Kehoe, M.D., Cincinnati, Ohio. C. Richard Walmer; M.D., Medical Director, Industrial Hygiene Foundation, Pittsburgh, Pennsylvania. Frode Jensen, M.D., Director, Graduate and Postgraduate Medical Education, University of Colorado School of Medicine, Denver, Colorado. Moderator: This is the last session of the first annual Rocky Mountain Confer ence on Industrial Health. I think you'll agree with me that during these sessions we have discussed a pretty broad field of scientific and human endeavor that over the years will pretty much make a major segment of American Industry. In talking about rebuilding that part of industry, we have been very serious in our discussions and other deliberations. I told my good friend Paul Richards last night there hasn't been a story told. We've been so intent on the subjects that we have covered. Perhaps I shouldn't deviate from that course, but I think maybe we ought to start out uhis morning with a little bit of laughter. Our good friend, Ted Waters, lias something to present to you that in substance too was in tended to remake part of the world, and I'd like to call on Ted this morn ing to read that little article that he has. Mr. Waters: I may say that Dr. Paul Richards is the author of this document and shares with me a headache from last night. The caption of it is the Morning After and the wife is speaking: Good morning, my bright international mate, My outstanding genius in problems of state; I trust all is clear in that wonderful mind, Which last night remodeled the whole of mankind. Your handling of Russia, the Ruhr and Palestine And charring Greece, it was masterly fine. You're sure to be named the man of the year, Here are four or five aspirins; swallow them, dear. Arise, my sweet prince, but be careful don't skid; Arise and consider the things that you did. The wrecked garden, the splintered garage; It sounded just like an old fashioned barrage. Go see your hostess and carry a check. I think if you'd sign it just "pain in the neck" The bank will okay it; it would have to be you That went berserk twixt the dawn and the dew. -32- within 12 to 2k months, and that's the way a good many of them have come about, A goodly number of us working in this particular field and whose life's efforts have been spent in this field of industrial toxicology, are more than a little skeptical on this approach to the problem and more than a little skeptical as to the business of the extension of these things in that fashion as any more than suggestions in relation to good occupational factors. It is like drunkenness in terms of a certain alcoholic concen tration which has crept into the statutes of two or three states. It's a very nice thing done for a very good purpose but it's very bad medicine. Moderator: Mr. Waters, is it your opinion that the concentration of less than 5 million particles of free silica, of less than 5 microns in diamter will not produce or cause the disease silicosis? I'm sure it should be put to a lawyer, not a doctor. Mr. Waters: I was delighted to hear Bob Kehoe's skepticism with respect to these MAC values that haveJbeen established in so many of the codes and I hope that industrial hygienists generally will come to share that skepticism! The present question is a serious question. I happened to be a member of the legal committee at the time of the National Silicosis Conference. I was on the legal committee and the particular question that has just been directed to me was fired around between the medical and the engineering committee, so I didn't have too much of an opportunity, nor did our com mittee have too much of an opportunity, in the first place we didn't know anything about it. I think so many of us that participated in that con ference were so lacking in basic knowledge. The fact is that in that con ference our learned brothers, that group of scientists who have spent a lifetime in the attempted research on that particular question, came out not with any positive statements but with a statement from their review of information then available to them, the permissible concentration of ex posure to silican dioxide dust should be kept below 5,000,000 particles per cubic foot of air of pure free silican dioxide. I've been at the con ferences at Saranac, I've heard LeRoy Gardner, who was certainly the greatesl authority on this subject, discuss this particular question. You get into the question of individual susceptibility. I had a case the other day who came to me from a silica company in the State of Pennsylvania and the man who for some k^ years had been engaged in a sand blast with that particular company, back in the days when industrial hygiene meant nothing, and the . fact that he came up really for retirement because of his age and was ex amined and it was determined that he had silicosis. He was disabled. There's a man who had been working under those conditions for some time, and John Smith working under the same conditions will get the disease, Bill Jones working right next to him will not. And Dr. Richards, you know that that's the story, and it's one of those explainable stories. Dr. Kehoe, in the laboratory work he is engaged in, is running down these things, trying to determine what are proper MAC'S. In the discussion that I presented to day, I was trying to follow the subject of scientists to tell you what little I know about that particular subject, but now as an advocate of in dustry, I share Dr. Kehoe's skepticism, not only for the employer, but also for the employee. This is not a one-way street; there are two parties that are involved in this thing. I share his skepticism in attempting to write into any given code a permissible MAC of any material. I have been repre senting recently the chrome industry with respect to the problem of the -33- +?C1^evne f lung carcinoma among chromate workers. I'd like to state that e Public Health Service is conducting an extehsive investigation into thdt particular subject and in all of these codes, I forget the figures, Dr. ' Kehoe you will correct me if I'm wrong, I think there's a permissible con centration of one-tenth of a milligram per dubic meter, but nobody knows what is the proper permissible concentration. I say to all of you in this ; particular part of the country that may be concerned with this matter of hygiene codes> study that very carefully before you establish any MAC m any industrial hygiene code. If you don't, industry is going ' o be exceedingly in the dark and the basic fact is that we are not going o accomplish the job that should be accomplished. Dust, as such, to answer the question that has been put to me, any silican dioxide dust to which empioyees are exposed, should be eliminated. We have engineering faculties and advice with respect to the control of their hazards and those of you gentlemeqnrho operate silica plants or have silica hazards or . Tai L ?e 1i co"Pounds to wdich Dr. Kehoe referred to a few momentsi fiGl SafS Wlth any Permissible MAC. Clean up your plants, you ` -+ean yCT O]?erations and eliminate those particular substanci s insofar as it is humanly possible to do so. :