Subject: Determination of Policy on Cases of Exposure to Occupational Disease.
ARMY SERVICE FORCES
UNITED STATES ENGINEER OFFICE
MANHATTAN DISTRICT
OAK RIDGE, TENNESSEE
24 Jul 1945
Subject: Determination of Policy on Cases of Exposure to Occupational Disease.
MEMORANDUM to
Major C. A. Taney, Jr.,
P.O. Box 42, Station ILLEGIBLE,
New York, New York.
1. In conference with officers of the Insurance Section and the Medical Section at the Clinton Engineer Works, they have pointed out a problem of importance to the District. They are now confronted with a case of nephritis for the first time in which it appears with some degree of probability that the disease was occasioned by exposure. The plant involved is Tennessee-Eastman Corporation. The woman plant worker involved was assigned to chemical recovery. She cleaned D units as they came from the tracks. Those units are still warm and fumes from "T" materials as well as NCL and CL are present during this operation. The worker began her employment in 1943 without pre-employment examination and has had almost two years of exposure. She is unaware of her condition which now shows up on routine physical checks and urinalysis.
2. The medical officers anticipate that we will have continued cases of this character. In some cases, there will be a permanent impairment of kidney functions. In simple terms, the filtering efficiency of the kidneys is impaired to the extent that there is a beginning trace of albumin in the urine and progressive uremic poisoning in the system which ultimately produces a high degree of toxicity. The patient in this condition is more vulnerable to an increase in kidney damage from such conditions as strep threat or similar infections.
3. In addition to nephritis, the incidence of discovered tuberculosis among employees is becoming manifest through more careful and frequent checks. Though in the opinion of the medical officers, plant conditions and materials are not the producing cause of the disease, we will face difficulty in disproving aggravation. The rate of discovery is now about one a week.
4. The employees must necessarily be rotated out, and not permitted to resume further exposure. In frequent instances no other type of employment is available. Claims and litigation will necessarily flow from the circumstances outlined.
5. The following critical problems are submitted to higher authority for determination of policy and guidance in the handling thereof:
a. Labor Relations:
Rotation of affected workers from present duties will invoke observation and comment on the part of other workers. Rotation is vital to the physical welfare of the workers but will undoubtedly invite suspicion and doubt in the minds of others about continuing their work. What policy or plan of rotation may be adopted so that it may be accomplished as diplomatically and expeditiously as possible without disturbing relations between employer and employee.
b. Morale:
Ancillary to the labor relations problem is that of morale of the workers. A knowledge on their part that their health is being or may be permanently impaired will have a drastic effect upon the spirit and willingness of the workers. What program or policy may be adopted so that morale may be maintained to the maximum efficiency possible.
c. Litigation and Claims:
Necessarily claims and litigation will result from occupational disease cases. The litigation itself is not of paramount consideration since it is a chronic problem of industry. There are certain related problems arising from it however. How and by what means is security to be maintained? How and in what manner may it be accomplished in the courts? Can we successfully fend off the postpone trial of numbers of cases? What policy is to be adopted generally with reference to procedural handling of occupational disease litigation? How, by whom and in what manner are the benefits of the health and hazards clause of the contract to be extended to such affected employees?
d. Security:
Security may be jeopardized in several ways. Rotation of employees may result in cessation of employment. In such event, the employee will doubtless seek independent medical attention which will result in inquiries about the manner and type of exposure. Ailment or illness of the employee who has terminated his duties will invite comment and questioning by friends, neighbors, and relatives. The prospect of litigation means that we must be prepared in all courts to meet and successfully combat the challenge to security. We will be dealing with perhaps five Circuit Courts of Tennessee and the United States District Court for the Eastern District of Tennessee. It is conceivable that we may be called upon to meet this challenge in various other courts. What overall policy and program should be adopted to solve these problems?
e. Ethical Considerations:
The feelings of the medical officers are keenly appreciated. Are they in accordance with their canons of ethics to be permitted to advise the patient of his true condition, its cause, effect, and probable prognosis? If not on ethical grounds, are they to be permitted to fulfill their moral obligation to the individual employee in so advising him: If not on moral grounds, are those civilian medical doctors employed here bound to make full disclosure to the patients under penalty of liability for malpractice or proceeding for revocation of license for their failure so to do?
6. Your consideration is invited to the submission and solution of these and related problems looking toward determination of policy for guidance of all concerned.
PHILIP J. CLOSE,
2nd Lt., J.A.G.D.
cc: Colonel S. L. Warren
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