Transcript of a J-M Medical Meeting at Manville on Conferences before Recording X-Ray Diagnoses (1957)

A twelve-page confidential transcript, dated May 10, 1957, of Dr. Kenneth Smith, J-M's medical director, speaking at a meeting at the Manville, New Jersey, plant on May 1, 1957, with Dr. D. T. DuBow, Dr. E. D. Merrill, H. M. Jackson and C. L. Sheckler. Smith proposes that when a periodic examination shows a suspected occupational disease, nothing be written in the medical file until the group has held a "conference" on the case, because of "this peculiar legislation that we have in New Jersey - that if we put down an impression today we can be damned for it at a future date." Doctors were to keep the X-ray in a "conference drawer" with a handwritten note that would be "removed and destroyed, so that we will have nothing in our records as to a diagnosis up to this point."

What it shows

Where a man's X-ray showed changes but his present job had no dust exposure, Smith said the file would describe only the shadow, with no diagnosis, "and then, we do not tell the man anything about that." Where the job was dusty, the plant manager would be asked to control the dust; Smith called this "still ethical" because nothing in the records "can say 'this is early silicosis' and which later can incriminate us if our diagnosis is wrong," and he did not think it "advisable at that time to tell the man the diagnosis." Men asking about their X-rays were to be reassured and, if need be, stalled "until we have had our conference"; X-rays were to be kept "out of the hands of the employee, so that he will not take those and shop around"; and outside consultants were not to be asked until the group had decided "what the implications are in the compensation and legal field." Smith described the purpose as "protecting the man from being harmed and protecting the company from a financial liability," and said that if a claim was likely, J-M should be ready "to pay the claim off immediately, as is our moral responsibility, without having to go to Court." He also proposed ending the green card and "no-dust" restriction because of their "very, very bad reputation" among plant people (compare DuBow's March memo on "No Dust" employees). The first three months of these conferences are reported in Sheckler's September memo.

In Johns-Manville's chronology

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

A meeting is held at Manville, N.J. on 5/1/57. Drs. K.W Smith, D.T. DuBow, and E.D. Merrill; H.M. Jackson and C.L. Sheckler are present. Helen A. Kamm prepares a transcript of the meeting on 5/10/57. Dr. Smith presents for discussion a new procedure whereby suspected occupational disease cases will be reviewed and discussed at a conference among the five before a final diagnosis is made and recorded. Dr. Smith explains that the reason for this new procedure is because of "the peculiar legislation that we have in New Jersey that if we put down an impression today we can be damned for it at a future date." At each conference, the medical file and X-rays of each case to be discussed will be present as well as the personnel file so that past exposures can be compared with X-ray changes.

Dr. Smith then discusses how to handle particular types of cases:

Case G1: Suspected Occupational Disease case where worker at present is not exposed to toxic material. Describe in the medical file the type of shadow appearing on the X-ray (where it is and how extensive it is) without recording a diagnosis, such as "fine nodulation typical of early silicosis." Note that the worker's X-ray changes are not due to present exposure, "and then, we do not tell the man anything about that. He just goes on like that. No dust restriction or medical restriction is given to the man or to the company. That's our responsibility, to care for the man and to protect management."

Case G2: Suspected Occupational Disease case where worker at present is exposed to toxic material. Sheckler is to notify the Plant Manager that a hazardous exposure on a particular job needs to be corrected, and then the task team approach needs to be initiated to control the hazard. "At that point, everything is still ethical. We have not identified a man with a disease without the man's knowing it. We have not indicated anything in our medical records which can say 'this is early silicosis' and which later can incriminate us if our diagnosis is wrong. But we have set in motion the wheels to elimination of the hazard to an employee or employees." The case is flagged and discussed again in 3-6 months at another conference. "Now, obviously, nothing is going to happen to the man in that short time." If the hazard can be controlled within a short time, describe in the medical file the type of shadow appearing on the X-ray without recording a diagnosis. "I don't think it is advisable at that time to tell the man the diagnosis." If, on the other hand, nothing has been done toward correcting the hazard, "then we've got to sit down with the Plant Manager and the division people at a special conference and say 'Listen, this man is going to be told that he should not work in this area, he has a medical restriction, and this is what it is going to mean to you in dollars and cents and trouble, and trial and tribulation.'"

Dr. Smith also discusses the procedures for handling T.B. cases (these can be occupational disease cases). Inactive T.B. cases are to be reviewed in conference in the same manner as suspected o.d. cases are.

Procedure regarding the calling in of outside consultants is to change. In the past, cases were routinely referred to outside consultants for diagnosis of a questionable shadow. This is not to be done any longer until a conference is held and the attendees have formed their own conclusions and understand the implications of the outside referral.

It is recommended that employees who have had X-ray changes and who ask about the results of their X-ray be "stalled off" until there has been a conference.

The justification for the conferences is summed up as follows: "We are in a position as a group, then, to take the responsibility of protecting the man from being harmed and protecting the company from a financial liability. And I think this group right here is a lot better equipped in our thinking than having the Plant Managers and their supervisors take over some of that responsibility, because their judgment in disease control is not as good as ours."

An advantage to the conference is that if the case is occupational and a claim is anticipated, the S-54 (work history) procedure can be begun immediately and quietly, "so we will be prepared to pay the claim off immediately, as is our moral responsibility, without having to go to Court. The main point in this whole business is to make up our own minds of what we should do medically and what the implications are in the compensation and legal field before we get anything in the medical records."

With respect to the green card system, Dr. Smith states that "I think, because of the very, very bad reputation that the green card and no-dust restriction has developed in the minds of the plant people, that we should stop completely."

Medical records are not to be released to outside doctors without the written consent of the employee. X-rays are to be sent directly to outside doctors and not given to the employee to transmit. "The main thing is to keep the X-rays out of the hands of the employee, so that he will not take those and shop around to 3 or 4 different doctors." It is suggested that J-M medical opinions or diagnostic readings of any films should not be given out to anybody such as the family doctor, until there is a conference concerning the case.