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  • 290 DistinguishingBetweenAsbestosisandSilicosis

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    Thalani Narasiya
    8 Ansichten9 Seiten
    ASBESTOS

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    290_DistinguishingBetweenAsbestosisandSilicosis(1)

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    8 Ansichten9 Seiten

    290 DistinguishingBetweenAsbestosisandSilicosis

    Hochgeladen von

    Thalani Narasiya
    ASBESTOS

    Copyright:

    © All Rights Reserved
    Als PDF herunterladen oder online auf Scribd lesen
    Markieren Sie unangemessene Inhalte
    von 9
    Litigation Management, In TWE REVIEW OF MEDICAL INFORMATION MANAGEMENT FoR LiTLaATION Published as an Educational Service to the Corporate, Insurance, and Defense Legal Community by Litigation Management, Ine. Volume VIII, Number 1 DISTINGUISHING BETWEEN ASBESTOSIS AND SILICOSIS: June 2005 A Lawyer's Primer on the Proper Diagnosis of Each Disease By F Ford Loker, Bxq. and Angela Whittaker-Pion, Esq. TThe aim of chis paper is to idencify 4 broad range of rests and findings in medical records thar defense arcorneys will need to master in onder to discuss the case in depth wich eheir chosen ex- pert witnesses, as well as perform effec- tive cross examination of plaincifis’ wit- nesses. Mentioning any aspect of che diagoosis of asbestos-related or silicate lared maladies, particularly the more coneroversial findings, should not bein ‘eepreted asthe authors’ endorsemene of ies relevance ot efficacy. Ashescos-elated disease claims have booen clogaing American courthouses — bue noe doctors’ offices — since che 1970's, In che past, progressive judges artempted innumerable fixes,” none of which succeeded in clearing theie dock- ‘ets permanently. Even che litigants themselves tried to orchestate 2 “global settlement mechanism, but ie was re- jected by the United Seates Supreme (Court — thus perpetuating the monss Now rumors are rife thar the United Scares Congress, at long last, Miles & Stockbridge P.C. will egislae an end co the lcigation cri- sis before any (or many) more bankrupt- cies take theie toll on the owners, in- vestors, and insurers of some of this countey’s largest and most essential businesses. Equally widespread are su- rs of the inevitable demise of the “Faimess in Asbestos Injury Resolution ‘Act of 2005" (the “FAIR Act”), because the eheee chief constituencies affected — former producers of asbestos and as- bestos-containing products, their insur- cs, and organized labor — cannot agree fn (1) how many dollars the trust fund will need co compensate potentially hhundceds of thousands of claimants; (2) which companies should contribute; (3) what amounts (or tiers) individual pay- crs should contribure; and (4) over what period of time. This may be the classic ‘example of the original proponents re- geetting what they wished for and launching a circular blame game to ex- plain the impasse ‘The Rand Corporation's Inseieuce for Civil Justice estimaced that, chrough 2002, 730,000 people filed asbestos | Tis ressee warp tm Cpoale Commons Onn Lips ragaren: For aoe mest Fn 04202, may ato deed hohe Ot (plies apron, et redeem, | estate a 444 2100 800778: bodily injury claims, and defendant ‘companies and insurers paid $70 billion in setelements and court judgments — with 59 percent ofthis amoune going to the areorneys on both sides. An addi- tional 100,000 asbestos-related lawsuits were filed in 2003, and about 600,000 claims are pending. Accuaries projec chat, withoue government ineervention, the cost of asbestos injury litigation could reach $265 billion. Ie is lictle wonder that certain entrepreneur lawyers and operators of mobile screen ing trailers continue to salivate over the ppocential profs. They are not above testing medical and legal limits to bring, rote claimants into the syseem, nor are they above using the same tactics 9 in crease case filings in silica litigation. Distinguishing Between Asbestosis and Silicosis: A Lawyer's Primer on the Proper Diagnosis of Each Disease Can Outsourcing the Medical Information Management Function Improve Your Client Service? Prognosticators a both ends ofthe trial table suggest that even | if “asbesees” goes away tornoerny, “silica” waits in che wings of che mass roets arena Ie is pecisely this dual csease issue chat has most reeently derailed swift passe of che FAIR Act: Asbestos and silica have been used since Biblical cimes in ‘countless industrial, commercial, and residential applications and products. Both are nacurally occurring minerals in vireu- ally inexhaustible supply. Both are celatively inexpensive and ‘hus desirable ingredients in many thousands of products. Ni ther substance, nor the illness claims chey spawn, is going co text the stage of American courtroom drama any time soon. To ‘equip jucies with the facrs to reach correct verdicts, defense lawyers firse must understand which diagnostic tools are em ployed to differentiate berween illnesses caused by asbestos and silica. IF the aromneys do nor perceive the differences, chey can roc educate juries on the subtle differences between asbestosis and silicosis, Uninformed jusors might saddle one industry with paying for ehe illnesses of the other — or even worse, allow double windfalls for a single, distince condicion, ‘The relatively recenc wave of silica-related lawsuic filings around the country, perhaps nor surprisingly, hos increased im direce proportion to rumors hac che FAIR Act of 2005 ‘would be enacted. Similarly, the up-tick in silica cases ight be linked to asbestos-re- lated tore reform legislation in several of the more active and problematic seates. For exam~ ple, ia Texas, Mississippi, Georgia, Illinois, Ohio, and Florida, there are ongoing effores 1 tighten venue rules, eliminate forum shopping, and require ‘objective signs of impairment before an asbestosis or pleural plaque claim receives a trial date. Are the silicosis claims “real, ‘or ace some folks hedging their bets, should an asbestos com- pensation fund or other ore reforms leave chem out in the cold? Paradoxically, slica-elazed deaths are decreasing,? while silico- sis case filings are skyrockecing. The silica plaintfis' bar seems inceac on following che path of leas resistance by forcing the round peg of silicosis inco che square hole of asbestosis. Ficcing them both into che same mold will noc do justice co either dis- ‘ease and lead to unnecessary frustration and confusion by courts, atvorneys, and jurors alike. are ‘Mass screening for asbestos-exposed workers proved so lu ‘rative, char it was lice wonder thac the same laboracories, che same clinicians, che same x-ray readers, and the same law firms went back ¢o the same well o tap inco the same reservoir of al- leged dust-disease victims, Mobile screening vans, with portable scray and spirometry equipment sharing space with the sponsor- ing lawfirm’s intake desk, were parked at union halls, motels, and shopping centers around the country: Reportedly, the per sons screened were not asked co pay for the rests. No one can argue that such a one-stop operation is very “customer friendly.” “Paradoxically, silica-related deaths are decreasing, while silicosis case filings Positive test results could eurn a patient ineo plaintiff, before the mobile “lab” drove to its next location “The screenings focused heavily on chest radiographs thac ‘were funneled ta few selece “B-readers.” A relatively recent phenomenon has the B-rcader who looks for silica exposure also documenting asbestos exposure, and vie wera. Ifthe x-ray is not clear for either mineral, ehe increasingly popular diagnosis of ‘mixed-duse pneumoconiosis (“MDP”) may be recorded. Re~ sercening of individuals already diagnosed with a nonmalignant asbestos lung disease ALD’) is curning up diagnoses of silicosis lor MDP, either in an heretofore missed conjunction of maladies of, even more remarkably, only evidence of silicosis and no crace of asbestosis in previously diagnosed cases of ALD. This finding has led to a joke making ehe rounds among counsel handling duse-disease cases: che cute for asbestosis finally has been founel its silicosis! Although a topic meriting is own article, it bears men- tioning here in passing that a least one court is euning an in- creasingly critical eye upon the legitimacy of mass screenings Federal Diserice Judge Janis Graham Jack presides over In Re Silica Products Liabiliy Litigation, MDL No. 1553 (S.D. Texas), encompassing. neatly 10,000 silica injury claims, In ‘mid-February Judge Jack con- 6 weeks), Acute Ose Spon 2. Past Metial History ‘Hospalnios aa Sri Girone ies Aches ken ibs Scat Hab leo nd cbse) Mega Dro Use 3. Review of Systems 1 Respewony Tubeless pore sine, expen. Tare Ifctins ai pigsons chickens, ol ABS Skep Apnea b.cardiovacula Myocarde Icon ar ack) Bypass Gn Sen Placement See Enbo Deep Venous Thrmbesis Angina ‘thy Face rer Defibeilacrimplanet Parogomal Nocturnal Dyspnea Gesation of waking up ping rar orbiting co sing poston abet Sola hing) Toner Clacton (eg psi walking) Congestive Here Flue hemic heart discs, pedal ‘sea sleek) ‘Ortopnes Glcp a too ore illo) . Newmologcal and Musculoskeletal Arh Rican or Degeest) Ryphoue Scola of he Spe RibPectaws June Pasa oe Dee Simple Deconiionng (to pinfal co walk or regulaely cca, out fate) Obese Endocrine Doss Nate Seoul Therapy Hypo ead 4, Family History Tie sr of pretsiblings, ae of and age at death Cancer chests rong blo eles eur um ldhod poe oi, kl x pig, bee Scena or ake home ds expose apna co sconhond sme (Utube sees Dancy bbe cri) Powe epoca fay) 5. Occupational History Allee DincesIndnet Exposures Dystander Mecha Alc ges in wok place Regularity, Frequency, Duration, Incense arm exporus) Peano Employee Papi, Xs, PFS ten) 6 Physical Examination ‘Genel appeaznce in the pink or "sichy") Healthy Complexion and Skin Head, Eyes, Er, Now Mentally rend Normal Gai and Agiley Dist Labor Beeting [Nomber and Quay of Resprations Vial Sign (pie, bad peessue, emer Palpacion an Ausculeaton of he Chase ales, cracls) Breach Sounds (wheaes, asp, dist Hear Sounds ips, muri gllops, eu) [Abdomen csi, enlarge livespleen) rari (clubbing, jas) Sung Sor Central nervous sytem evluation 7 Laboratory Tests 2 Chest Radiographs (X-rays, CT Seans, HiRes ‘Caren and Historical Pesitioning (AP, PA, Lateral, Supine, Prone) Film Quali Bercding Parenchymal Abnormalities Pleural Abotmaiis Steleal or Canue Abooemaltes Diaphngmatic Abnormalities Bacal Spmmeey oe Dee CCacnomalmases ‘Accumulation of laid bs, Pulmonary Fusesion Testing! Current and Histol Historical Consistency of Progeson Reliable Lib and Equipmese Experienced Techn Raw Data Reproducibility (cosisteae flow curves fram shih petit vals selcee Accurate Age, Weigh, Race and Patent Daca Reco «. Spiromeery vc FEV FEV /FVC FEF 25% -75% forsmall away fncron FEE 755 4. Lang Volumes Pethyamageaphy (Boy Box) Helm or Nitmgen ilaion ie FRC ERV RV RvITIC «. Diffusion Capacity Tsvolume consistent with ther PFE? Tg DICO caret for alveolar volume (AVY? 8. tnvasive Procedures Bronchescoy Bopry (nel open) Bronchoalveolar Lavage Thomcenees Thanet Glee Pll Biogsy experts frequently appearing on both sides of asbestos law- suits, including Viceor L. Roggli, M.D., Jerod L. Abraham, MD. and Allen R. Gibbs, MID. They summarize the main facutes of MDP in the Abstract We defined mixed-duse pneumoconiosis (MDP) pathologically as pneumoconiosis showing, dust macules of mixed-duse fibrotic nodules (MDE), with of without silicotic nodules (SN), in an indi Vidual with a history of exposure co mixed duse...According to our definition of MDP, chere- fore MDE should outnumber SN in che lung ¢0 make the pathologic diagnosis of MDP... The clini- cal diagnosis of MDP requires the exclusion of other ‘well-defined pneumoconioses...Lrregular opacities are the major radiographic findings in MDP (ILO 1980), in contrast to silicosis, in which small (Other potential substances include: benconite exposures can occur during oil well drilling; benconite may also be used as a binding agent added to silica sand), aypsum (plaster board), vermiculite (insulators), beryllium (metals), cade mium (pigments, paints, ceramics, glass, plastics, and leather), manganese (mining and crushing), and nickel (elec~ troplating, enamels). Although beyond the scope of this article, i is also im: pportane to keep in mind that, depending upon the person's exposure history, certain fungal, animal, chemical, baccerial, and unknown causes chat are associated wieh lung injury and ‘mimic those caused by dust also muse be ruled out, in addi ‘ion to the more traditional diseases associared with exposure to silica, asbestos, and other minerals, elements, or com: pounds, IIL CONCLUSIO rounded opacities pre- oo “Frequently, a worker will have Niece MDPmu ™dxed exposures, and as a result, be distinguished froma ‘it Ss Necessary to be thorough variety of nonoccupa- in determining whether (and what) other conditions exist in the worker.” Ofcourse, engaging the best medical experts in the field of diagnosing pneumo- conioses is essential, bue legal practitioners will noc know whom to call without the basic understanding of the clues buried in a plain. tional interstitial pul- monary disorders Honma, K. etal, “Pro- sed Criteria for Misied-dust Definition, Descriptions and Guidelines for Pathologic Diagness and Clinical Carnation," HUMAN PATHOLOGY, 35 (2004); 1515-23, Many of the occupational exposure sites and occupations normally associated with silica and asbestos exposures are also considered potential mixed-

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