Dr. T. H. Davison to H. M. Jackson on the Standard Procedure for Counseling Pneumoconiosis Cases (1971)

A two-page confidential memo of January 4, 1971, from Dr. T. H. Davison, J-M's medical director, writing from Waukegan, to H. M. Jackson at J-M headquarters, on a "Standard Procedure for Work Restrictions and Counseling of Pneumoconiosis Cases" for the company's Manual of Standard Practices. Davison objects that Jackson's revision of December 22, 1970 kept "very little of the original intent" of the procedure he had proposed on October 29, 1970 and that J-M president C. B. Burnett and the Policy Committee Task Force had approved. He wanted the standard to speak of "pneumoconiosis cases," meaning lung scarring from work, not the vaguer "employees with pulmonary impairments."

What it shows

Under Davison's procedure the plant doctor first arranged a job change through the employee's supervisors and only then told the worker his diagnosis. Davison defends that order: more than 70% of J-M's pneumoconiosis cases were at Manville or Waukegan, where full-time company doctors knew the jobs, and telling supervisors first avoided an employee coming back to his department with news of a transfer it had not prepared for. He would leave it to each doctor whether to show the worker his chest X-ray, noting that most patients "never see their x-rays." He closes that the system had produced "a rapport between the company and the patient/employees significantly better than in most of our plant and mine locations since its implementation more than 15 years ago." Handwritten margin notes by a reader question several of his points. The procedure was then reviewed with the Manville plant staff in February.

In Johns-Manville's chronology

Johns-Manville's own chronology of what the company knew describes this document as follows:

Dr. Davison memorandum to Jackson, dated 1/4/71, responds to Jackson's suggestions regarding revisions to the Standard Procedure for Work Restrictions and Counseling of Pneumoconiosis Cases as outlined in Dr. Davison's letter of 10/29/70. Dr. Davison comments that Jackson's suggested revisions are contrary to the original intent of the Standard procedure. The following are Dr. Davison's criticisms of Jackson's suggestions:

1. Jackson recommends that the title of the Standard Procedures be changed from "Procedure for Work Restrictions and Counseling of Pneumoconiosis Cases" to that of "Procedure for Establishing Work Restrictions and Counseling Employees with pulmonary Impairments." Dr. Davison believes that the standard should specifically address "pneumoconiosis cases" and not "pulmonary impairment cases."

Dr. Davison states that many cases, if diagnosed early, will not have any evidence of pulmonary impairment. Also, many pulmonary impairment cases are of a non-occupational origin (emphysema, bronchiectasis, asthma, etc.). Dr. Davison wants it clear that the standard addresses pulmonary fibrosis of occupational origin and believes that the use of the word "pneumoconiosis" accomplishes this.

2. Jackson criticizes the sequence set forth for counseling of pneumoconiosis cases. Under the current Standard, the employee is not told of his condition until the plant doctor notifies the employee's supervisor and proper work restrictions have been initiated (job transfer, respirator issued, etc.). Jackson is concerned that the plant doctor does not know enough about the plant conditions to make a job change recommendation.

Dr. Davison assures Jackson that this is not so, especially at Manville and Waukegan, where more than 70% of the pneumoconiosis cases are. Dr. Davison also supports this procedure because it prevents the difficult situation of an employee confronting an unprepared supervisor with the information that the plant doctor advises a job transfer for him.

3. Jackson also suggests that the Standard Procedure include a requirement that the counseling plant doctor review the employee's chest X-ray with the employee. Dr. Davison believes that this should be left to the discretion of the doctor involved.

Dr. Davison is anxious to test the Standard Procedure as outlined in his letter of 10/29/70 and as approved by Burnett and the Policy Committee Task Force. Dr. Davison emphasizes that he is particularly impressed with this Standard Procedure, which has shown itself not only practical in application but "has resulted in a rapport between the company and the patients/employees significantly better than in most of our plant and mine locations since implementation more than 15 years ago."