RICHARD CARLSTRAND v. AERCO INTERNATIONAL, INC et al, 190194/2017, 253 (N.Y. Sup. Ct., New York County Jul. 17, 2019) (2024)

`

`FILED: NEW YORK COUNTY CLERK 07/17/2019 09:27 AM
`NYSCEF DOC. NO. 253
`
`INDEX NO. 190194/2017
`
`RECEIVED NYSCEF: 07/17/2019
`
`effusion.
`
`Bilateral
`
`pleural
`
`calcifications
`
`were
`
`indicated
`
`as
`
`probably
`
`related
`
`to
`
`pnor
`
`asbestos
`
`exposure.
`
`PATHOLOGY
`
`REPORTS:
`
`Report
`
`from
`
`South
`
`Miami
`
`Hospital
`
`(SM S -
`
`17 -
`
`04085,
`
`May
`
`1, 2017)
`
`diagnosed
`
`two
`
`pleural
`
`biopsies
`
`both
`
`as
`
`"malignant
`
`mesothelioma".
`
`Tumor
`
`cells
`
`were
`
`reported
`
`positive
`
`for WT1,
`
`calretinin
`
`and CK 5 but
`
`negative
`
`Consultative
`
`report
`
`from
`
`Memorial
`
`Sloan
`
`Cancer
`
`Center
`
`performed
`
`molecular
`
`Kettering
`
`for TTF-1.
`(M 17 - 22580,
`
`August
`
`22,
`
`2017
`
`analysis
`
`on
`
`this
`
`material
`
`and
`
`identified
`
`mutation
`
`of BAP
`
`1. The
`
`consultative
`
`diagnosis
`
`material
`this
`of
`mesothelioma"
`
`was
`
`"malignant
`
`epithelioid
`
`neoplasm,
`
`consistent
`
`with
`
`malignant
`
`Tumor
`
`cells
`
`were
`
`reported
`
`positive
`
`for WT1,
`
`calretinin
`
`and
`
`CK 5 but
`
`negative
`
`for TTF-1.
`
`PATHOLOGY
`
`MATERIALS:
`
`I
`
`received
`
`two H&E
`
`stained
`
`glass
`
`slides
`
`both
`
`labeled
`
`"SMS
`
`-
`
`17 - 04085".
`
`Microscopic
`
`examination
`
`demonstrated
`
`bi0psica
`
`of parietal
`
`pleura
`
`including
`
`chest
`
`wall
`
`soft-tissue
`
`showing
`
`extensive
`
`involvement
`
`by malignant
`
`epithelioid
`
`neoplasm.
`
`Tumor
`
`cells
`
`were
`
`large
`
`with
`
`large
`
`rounded
`
`nuclei
`
`showing
`
`coarse
`
`chromatin
`
`and
`
`small
`
`nucleoli.
`
`Scattered
`
`mitotic
`
`figures
`
`were
`
`detected.
`
`Tumor
`
`cells
`
`showed
`
`abundant
`
`eosinophilic
`
`cytoplasm
`
`rounded/epithelioid
`
`appearance.
`
`Tumor
`
`cells
`
`were
`
`present
`
`in
`
`nests
`
`and
`
`cords
`
`with
`
`with
`
`extensive
`
`invasion
`
`and
`
`into
`
`chest
`
`wall
`
`destructive
`
`throughout
`
`pleura
`
`adipose
`
`tissue.
`
`I
`
`received
`
`one
`
`H&E
`
`stained
`
`glass
`
`slide
`
`labeled
`
`"SCB
`
`-
`
`17
`
`-
`
`00524".
`
`Microscopic
`
`examination
`
`d ernon
`
`strated
`
`cellblock
`
`preparation
`
`of
`
`fluid
`
`specimen
`
`showing
`
`innumerable
`
`clusters
`
`of
`
`large
`
`malignant
`
`epithelioid
`
`cells
`
`similar
`
`to previous.
`
`Tumor
`
`cells
`
`were
`
`large
`
`with
`
`large
`
`rounded
`
`nuclei
`
`showing
`
`vesicular
`
`chromatin
`
`and
`
`abundant
`
`eosinophilic
`
`cytoplasm.
`
`2
`
`

`

`FILED: NEW YORK COUNTY CLERK 07/17/2019 09:27 AM
`NYSCEF DOC. NO. 253
`
`INDEX NO. 190194/2017
`
`RECEIVED NYSCEF: 07/17/2019
`
`Based
`
`on my
`
`review
`
`of
`
`records
`
`and
`
`tissues,
`
`my
`
`diagnosis
`
`is as
`
`follows:
`
`Pleura
`
`and
`
`pleural
`
`fluid
`
`(SMS
`
`-
`
`17 - 04085
`
`& SCB -
`
`17 - 00524):
`
`-
`
`Malignant
`
`Pleural
`
`Mesothelinma,
`
`epithelioid
`
`type.
`
`ASBESTOS
`
`EXPOSURE
`
`HISTORY:
`
`Answers
`
`different
`
`to interrogatory
`
`questions
`
`indicated
`
`Mr.
`
`Carlstrand
`
`was
`
`exposed
`
`to a variety
`
`asbestos-containing
`
`products
`
`and
`
`equipment
`
`during
`
`his
`
`employment
`
`as
`
`of
`
`a
`
`carpenter
`
`and
`
`a landscaper.
`
`Exposure
`
`included
`
`but
`
`not
`
`limited
`
`to auto
`
`brakes,
`
`engines
`
`and
`
`engine
`
`gaskets,
`
`acoustical
`
`spray,
`
`floor
`
`tile,
`
`fire
`
`doors,
`
`joint
`
`compound,
`
`lawnmower
`
`sheet
`
`sheetrock
`
`and
`
`roofing.
`
`Specific
`
`brakes,
`
`auto
`
`clutches,
`
`ceiling
`
`tile,
`
`flooring
`
`products
`
`and
`
`product
`
`manufacturers
`
`are
`
`listed.
`
`A chart
`
`of work
`
`history
`
`indicated
`
`asbestos
`
`exposures
`
`began
`
`in
`
`1959-
`
`1962
`
`when
`
`he was
`
`working
`
`as
`
`an Assistant
`
`Auto
`
`Mechanic,
`
`from
`
`1960-1977
`
`then
`
`again
`
`from
`
`1985-2004
`
`while
`
`he worked
`
`as a Carpenter
`
`and
`
`from
`
`1975-1985
`
`as a Landscaper.
`
`I
`
`reviewed
`
`six
`
`volumes
`
`of deposition
`
`testimony
`
`of Mr.
`
`Carlstand
`
`taken
`
`August
`
`8, 2017.
`
`Deposition
`
`interrogatory
`
`1972-1977
`
`testimony
`
`generally
`
`corroborated
`
`the
`
`asbestos
`
`exposure
`
`outlined
`
`in
`
`the
`
`answers.
`
`Mr.
`
`Car1stand
`
`testified
`
`that
`
`he was
`
`exposed
`
`to
`
`asbestos
`
`home
`
`construction.
`
`asbestos
`
`from
`
`dust
`
`during
`
`He
`
`testified
`
`that
`
`he
`
`breathed
`
`during
`
`the
`
`installation
`
`process
`
`of
`
`the
`
`boiler.
`
`He
`
`testified
`
`about
`
`specifies
`
`of
`
`asbestos
`
`products
`
`that
`
`were
`
`used
`
`on
`
`the
`
`boiler
`
`that
`
`created
`
`visible
`
`dust
`
`that
`
`he
`
`breathed.
`
`He
`
`also
`
`testified
`
`he
`
`was
`
`exposed
`
`to
`
`visible
`
`asbestos
`
`dust
`
`during
`
`installation,
`
`taping,
`
`spackling
`
`and
`
`sanding
`
`of sheetrock
`
`at his
`
`home.
`
`Mr.
`
`Carlstand
`
`testified
`
`he was
`
`exposed
`
`to asbestos
`
`during
`
`installation
`
`of a roof
`
`at
`
`this
`
`house.
`
`He
`
`also
`
`testified
`
`he was
`
`exposed
`
`to visible
`
`asbestos
`
`dust
`
`during
`
`sheet
`
`flooring
`
`installation
`
`in the
`
`kitchen.
`
`Mr.
`
`Carlstrand
`
`testified
`
`that
`
`while
`
`renovating
`
`a garage
`
`apartment
`
`he was
`
`exposed
`
`to asbestos
`
`dust.
`
`He
`
`testified
`
`that
`
`he
`
`removed
`
`existing
`
`plaster
`
`and
`
`wood
`
`lath
`
`and
`
`replaced
`
`it with
`
`sheetrock
`
`that
`
`was
`
`taped,
`
`spackled
`
`and
`
`sanded.
`
`At another
`
`residence
`
`Mr. Carlstrand
`
`testified
`
`that
`
`he was
`
`present
`
`when
`
`a fuel
`
`oil
`
`company
`
`repaired
`
`the
`
`boiler.
`
`He
`
`testified
`
`that
`
`when
`
`the
`
`old
`
`boiler
`
`head
`
`was
`
`replaced,
`
`they
`
`had
`
`to peel
`
`off
`
`the
`
`asbestos
`
`insulation
`
`covering
`
`which
`
`crated
`
`visible
`
`dust
`
`the
`
`he
`
`breathed.
`
`It was
`
`very
`
`loose
`
`and
`
`dusty
`
`and
`
`had
`
`to be swept
`
`up
`
`3
`
`

`

`FILED: NEW YORK COUNTY CLERK 07/17/2019 09:27 AM
`NYSCEF DOC. NO. 253
`
`INDEX NO. 190194/2017
`
`RECEIVED NYSCEF: 07/17/2019
`
`quite
`
`often
`
`again
`
`creating
`
`visible
`
`dust.
`
`Mr.
`
`Carlstrand
`
`testiñed
`
`he was
`
`exposed
`
`to
`
`asbestos
`
`while
`
`working
`
`at
`
`a gas
`
`station
`
`replacing
`
`brake
`
`shoes
`
`and
`
`performing
`
`clutch
`
`work
`
`and
`
`the
`
`brake
`
`and
`
`clutch
`
`pads
`
`would
`
`create
`
`lots
`
`of visible
`
`dust.
`
`He
`
`testified
`
`dust
`
`was
`
`also
`
`created
`
`the
`
`brake
`
`and
`
`clutch
`
`pads
`
`edges.
`
`Mr.
`
`by
`
`sanding
`
`to take
`
`off any
`
`sharp
`
`Carlstrand
`
`testified
`
`he was
`
`exposed
`
`to
`
`asbestos
`
`while
`
`working
`
`as
`
`a carpenter
`
`for
`
`a
`
`company
`
`ceiling
`
`ceiling
`
`that
`
`installed
`
`acoustical
`
`ceilings
`
`and
`
`partitions.
`
`He testified
`
`that
`
`the
`
`acoustical
`
`tiles,
`
`sheetrock,
`
`taping
`
`compound
`
`and
`
`an
`
`adhesive
`
`that
`
`stuck
`
`the
`
`acoustical
`
`to the
`
`existing
`
`ceiling
`
`all
`
`contained
`
`asbestes.
`
`He
`
`also
`
`testified
`
`that
`
`this
`
`time
`
`he worked
`
`alongside
`
`other
`
`trades
`
`using
`
`aebestes
`
`containing
`
`products.
`
`Including:
`
`air
`
`conditioning,
`
`heating
`
`and
`
`soundproofing
`
`laborers.
`
`He
`
`testified
`
`that
`
`the
`
`air
`
`conditioner
`
`workers
`
`installed
`
`insulated
`
`pipes
`
`and
`
`valves
`
`that
`
`went
`
`to
`
`and
`
`from
`
`the
`
`individual
`
`units.
`
`He testified
`
`that
`
`the
`
`insulation
`
`contained
`
`asbestos
`
`and
`
`created
`
`visible
`
`dust
`
`also
`
`used
`
`insulation
`
`on
`
`the
`
`during
`
`that
`
`he breathed.
`
`He
`
`testified
`
`that
`
`the
`
`heating
`
`workers
`
`pipes
`
`and
`
`valves
`
`that
`
`contained
`
`asbestos.
`
`Mr.
`
`Carlstrand
`
`testified
`
`that
`
`the
`
`sound-
`
`proofers
`
`created
`
`a lot
`
`of dust
`
`pouring
`
`the
`
`soundproofing
`
`material.
`
`They
`
`would
`
`spray
`
`it
`
`with
`
`a
`
`gun
`
`and
`
`trowel
`
`it where
`
`the
`
`gun
`
`couldn't
`
`reach.
`
`He
`
`testified
`
`this
`
`material
`
`asbestos.
`
`Mr.
`
`testified
`
`that
`
`laborers
`
`contained
`
`Carlstrand
`
`cleaned
`
`and
`
`swept
`
`up
`
`debris
`
`on
`
`off
`
`the work
`
`site
`
`that
`
`created
`
`a lot
`
`of dust.
`
`He
`
`testified
`
`that
`
`on
`
`one
`
`job
`
`he
`
`had
`
`to scrape
`
`pre-existing
`
`spray-on
`
`insulation
`
`with
`
`a floor
`
`scraper
`
`and
`
`that
`
`insulation
`
`contained
`
`asbestos.
`
`Mr.
`
`Carlstrand
`
`testified
`
`that
`
`while
`
`wus king
`
`as
`
`a journeyman
`
`carpenter
`
`he
`
`was
`
`exposed
`
`to asbestos
`
`from
`
`acoustic
`
`sheetrock
`
`he was
`
`tiles,
`
`and
`
`adhesive,
`
`He testified
`
`exposed
`
`to
`
`asbestos
`
`from
`
`other
`
`trades
`
`including:
`
`air
`
`handlers,
`
`heaters,
`
`pipers,
`
`knockers
`
`and
`
`steam
`
`fitters.
`
`He
`
`testified
`
`that
`
`the
`
`pipe
`
`and
`
`valve
`
`insulation
`
`installed
`
`these
`
`workers
`
`contained
`
`asbestos
`
`that
`
`created
`
`visible
`
`dust
`
`that
`
`he
`
`breathed.
`
`Carlstrand
`
`testified
`
`he
`
`was
`
`asbestos
`
`when
`
`he
`
`was
`
`present
`
`tin
`
`by
`
`Mr.
`
`the
`
`exposed
`
`to
`
`during
`
`installation
`
`of vinyl
`
`asbestos
`
`floor
`
`tile
`
`and
`
`cutting
`
`of
`
`the
`
`tile
`
`created
`
`dust.
`
`He
`
`testified
`
`that
`
`he was
`
`exposed
`
`to
`
`asbestos
`
`from
`
`retrieving
`
`vinyl
`
`asbestos
`
`floor
`
`tile
`
`in
`
`storage.
`
`Workman
`
`in the
`
`storage
`
`area
`
`were
`
`covering
`
`pipes
`
`and
`
`valves
`
`with
`
`asbestos
`
`compounds.
`
`Mr.
`
`Carlstrand
`
`testified
`
`that
`
`he was
`
`asbestos
`
`when
`
`workmen
`
`cleaned
`
`work
`
`exposed
`
`to
`
`areas
`
`that
`
`created
`
`a lot
`
`of dust.
`
`He testified
`
`that
`
`he was
`
`present
`
`when
`
`the
`
`fireproof
`
`doors
`
`were
`
`installed.
`
`Installation
`
`involved
`
`drilling
`
`for
`
`the
`
`knobs,
`
`hardware,
`
`closers
`
`and
`
`push
`
`bars
`
`which
`
`created
`
`asbestos
`
`dust
`
`as well.
`
`Mr.
`
`Carlstrand
`
`testified
`
`that
`
`while
`
`working
`
`as
`
`a journeyman
`
`carpenter
`
`he was
`
`exposed
`
`to
`
`asbestos
`
`by
`
`handling
`
`acoustic
`
`ceiling
`
`4
`
`

`

`FILED: NEW YORK COUNTY CLERK 07/17/2019 09:27 AM
`NYSCEF DOC. NO. 253
`
`INDEX NO. 190194/2017
`
`RECEIVED NYSCEF: 07/17/2019
`
`tiles,
`
`sheetrock,
`
`joint
`
`compound
`
`and
`
`fire
`
`doors.
`
`He testified
`
`that
`
`he used
`
`a jig
`
`for
`
`drilling
`
`holes
`
`in the
`
`lock
`
`set,
`
`door
`
`closer,
`
`and
`
`push
`
`levers
`
`of
`
`the
`
`fire
`
`doors.
`
`He
`
`testified
`
`that
`
`this
`
`drilling
`
`supervisor
`
`process
`
`created
`
`a lot
`
`of dust.
`
`Mr.
`
`Carlstrand
`
`testified
`
`that
`
`he was
`
`promoted
`
`to
`
`foreman
`
`/
`
`and
`
`visited
`
`many
`
`job
`
`sites
`
`where
`
`the
`
`aforementioned
`
`work
`
`was
`
`being
`
`performed,
`
`exposing
`
`him to asbestos.
`
`In addition,
`
`he testified
`
`that
`
`he was
`
`exposed
`
`to asbestos
`
`when
`
`working
`
`as
`
`a supervisor
`
`foreman
`
`/
`
`in
`
`storage
`
`areas
`
`where
`
`asbestos
`
`covered
`
`boilers
`
`were
`
`dust.
`
`He
`
`being
`
`worked
`
`on.
`
`He
`
`testjfied
`
`that
`
`there
`
`was
`
`a lot
`
`of
`
`testified
`
`that
`
`he was
`
`also
`
`present
`
`when
`
`the
`
`work
`
`area
`
`was
`
`being
`
`cleaned
`
`and
`
`swept
`
`which
`
`created
`
`a lot
`
`of dust.
`
`Mr.
`
`Carlstrand
`
`testified
`
`that
`
`he was
`
`exposed
`
`to
`
`asbestos
`
`while
`
`servicing
`
`five
`
`or
`
`six
`
`lawn
`
`tractors
`
`when
`
`he was
`
`a landscaper
`
`from
`
`1975-1985.
`
`Servicing
`
`included
`
`but
`
`was
`
`not
`
`limited
`
`to:
`
`asbestos
`
`brake
`
`pads,
`
`clutches,
`
`and
`
`engine
`
`gaskets.
`
`These
`
`repairs
`
`created
`
`a lot
`
`of dust
`
`and
`
`debris.
`
`SUMMARY:
`
`Based
`
`an my
`
`review
`
`of
`
`the medical
`
`records
`
`including
`
`pathology
`
`materials,
`
`I conclude
`
`that
`
`Mr.
`
`Carlstrand
`
`malignant
`
`had
`
`mesothelioma
`
`of
`
`the
`
`pleura
`
`and
`
`bilateral
`
`pleural
`
`plaques.
`
`significant
`
`The
`
`exposure
`
`information
`
`of Mr.
`
`Carlstrand
`
`that
`
`I
`
`reviewed
`
`identifies
`
`a
`
`history
`
`of asbestos
`
`exposure.
`
`Additionally,
`
`the
`
`diagnosis
`
`of bilateral
`
`calcified
`
`pleural
`
`plaques
`
`provides
`
`further
`
`evidence
`
`of prior
`
`asbestos
`
`exposures.
`
`Mr.
`
`Carlstrand
`
`developed
`
`malignant
`
`mesotheliema
`
`after
`
`an
`
`appropriate
`
`latency
`
`period
`
`following
`
`his
`
`first
`
`known
`
`exposures
`
`to asbestos.
`
`The
`
`occurrence
`
`of
`
`mesothelioma
`
`is
`
`associated
`
`with
`
`asbestos
`
`exposure,
`
`and
`
`mesothelioma
`
`is
`
`considered
`
`by many
`
`sources
`
`to
`
`be
`
`a signal
`
`tumor,
`
`meaning
`
`it
`
`signals
`
`asbestos
`
`exposure.
`
`Scientifically
`
`speaking,
`
`it
`
`is not
`
`one
`
`asbestos
`
`prior
`
`fiber
`
`or
`
`one
`
`exposure,
`
`to
`
`the
`
`exclusion
`
`and medically
`of
`other
`
`exposures
`
`that
`
`causes
`
`a person's
`
`mesothelioma.
`
`Mesothelioma
`
`is
`
`caused
`
`by
`
`the
`
`totality
`
`of
`
`asbestos
`
`exposures,
`
`often
`
`called
`
`cumulative
`
`dose,
`
`that
`
`an
`
`individual
`
`is exposed
`
`to
`
`over
`
`his
`
`or her
`
`lifetime,
`
`taking
`
`into
`
`account
`
`an
`
`appropriate
`
`latency
`
`period.
`
`A mesothelioma
`
`occurs
`
`only
`
`after
`
`repeated
`
`exposures
`
`to
`
`asbestos
`
`over
`
`time,
`
`which
`
`in
`
`turn
`
`causes
`
`repeated
`
`damage
`
`to
`
`the
`
`mesothelial
`
`DNA and
`
`leads
`
`to mutations.
`
`It
`
`is well
`
`established
`
`that
`
`even
`
`brief
`
`or
`
`low
`
`exposures
`
`to
`
`asbestos
`
`can
`
`cause
`
`mesothelioma;
`
`however,
`
`it
`
`is
`
`also
`
`important
`
`to
`
`5
`
`

`

`FILED: NEW YORK COUNTY CLERK 07/17/2019 09:27 AM
`NYSCEF DOC. NO. 253
`
`INDEX NO. 190194/2017
`
`RECEIVED NYSCEF: 07/17/2019
`
`recognize
`
`that
`
`mesothelioma
`
`is
`
`a
`
`dose
`
`response
`
`disease.
`
`That
`
`means
`
`from
`
`an
`
`epidemiologic
`
`perspective,
`
`the
`
`greater
`
`the
`
`dose
`
`of
`
`asbestos,
`
`the
`
`greater
`
`the
`
`chance
`
`a
`
`given
`
`individual
`
`will
`
`develop
`
`mesothelioma,
`
`thus
`
`smaller
`
`exposures
`
`contribute
`
`smaller
`
`risks
`
`and
`
`larger
`
`exposures
`
`contribute
`
`larger
`
`risks.
`
`It
`
`is well
`
`established
`
`that
`
`exposure
`
`to
`
`both
`
`chrysotile
`
`and
`
`amphibole
`
`asbestos
`
`causes
`
`malignant
`
`mesothelioma.
`
`review
`
`an
`
`the
`
`causation
`
`When
`
`I
`
`I
`
`individual's
`
`exposure
`
`to
`
`asbestos
`
`and
`
`evaluate
`
`of disease,
`
`as
`
`have
`
`done
`
`in
`
`this
`
`case,
`
`1 do
`
`not
`
`state
`
`that
`
`any
`
`contributor
`
`to
`
`the
`
`cumulative
`
`dose,
`
`no
`
`matter
`
`how
`
`small,
`
`is a significant
`
`factor
`
`to the
`
`development
`
`of mesothelioma.
`
`Rather,
`
`I
`
`review,
`
`evaluate,
`
`and
`
`consider
`
`the
`
`information
`
`available
`
`to me about
`
`an
`
`individual's
`
`identified
`
`exposures
`
`to asbestos,
`
`and
`
`only
`
`after
`
`that
`
`review
`
`will
`
`I consider
`
`causation
`
`and
`
`attribution
`
`of
`
`the
`
`asbestos
`
`exposures.
`
`review
`
`is
`
`in
`
`context
`
`of additional
`
`opinions
`
`and
`
`foundation
`
`as
`
`stated
`
`in my
`
`affidavit
`
`of April
`
`15,
`
`2016,
`
`provided
`
`separately
`
`or attached
`
`to this
`
`report.
`
`My
`
`done
`
`the
`
`Based
`
`on
`
`the
`
`information
`
`available
`
`to me,
`
`that
`
`I have
`
`reviewed
`
`in
`
`this
`
`case
`
`and
`
`is
`
`described
`
`above,
`
`Mr. Carlstrand
`
`had
`
`significant
`
`exposures
`
`to asbestos
`
`and
`
`proximate
`
`work
`
`with
`
`and
`
`around
`
`asbestos
`
`containing
`
`products,
`
`from
`
`over
`
`his
`
`his
`
`frequent
`
`working
`
`lifetime.
`
`It
`
`is my
`
`opinion
`
`to a reasonable
`
`degree
`
`of medical
`
`certainty
`
`that
`
`Mr. Carlstrand
`
`and
`
`pleural
`
`has
`
`a malignant
`
`meanthelioma
`
`plaques
`
`that
`
`were
`
`caused
`
`by
`
`these
`
`identified
`
`and
`
`substantial
`
`exposures
`
`to asbestos.
`
`It
`
`is
`
`also my
`
`opinion
`
`to
`
`a reasonable
`
`degree
`
`of medical
`
`certainty
`
`that
`
`the
`
`cumulative
`
`exposures
`
`to asbestos
`
`from
`
`each
`
`company's
`
`product
`
`or products
`
`identified
`
`in testimony
`
`was
`
`a substantial
`
`contributing
`
`factor
`
`to the
`
`overall
`
`cumulative
`
`dose
`
`of asbestos
`
`and
`
`the
`
`development
`
`of Mr.
`
`Carlstrand's
`
`malignant
`
`mesothelioma.
`
`I will
`
`supplement
`
`or amend
`
`this
`
`report
`
`as appropriate,
`
`if additional
`
`information
`
`becomes
`
`available.
`
`6
`
`Sincerely,
`
`Brent
`
`C. Staggs,
`
`M.D.
`
`

`

`FILED: NEW YORK COUNTY CLERK 07/17/2019 09:27 AM
`NYSCEF DOC. NO. 253
`
`INDEX NO. 190194/2017
`
`RECEIVED NYSCEF: 07/17/2019
`
`AFFIDAVIT
`
`OF BRENT
`
`C. STAGGSt
`
`M.D.
`
`I, Brent
`
`C. Staggs,
`
`M.D.,
`
`am over
`
`18 years
`
`of age,
`
`being
`
`duly
`
`sworn,
`
`depose
`
`and
`
`state
`
`as
`
`follows:
`
`I am a physician
`
`and
`
`partner
`
`with
`
`Pathology
`
`Laboratories
`
`of Arkansas,
`
`P.A.
`
`1
`
`received
`
`my medical
`
`degree
`
`from
`
`the
`
`University
`
`of Arkansas
`
`for Medical
`
`Sciences
`
`in
`
`2001
`
`and.
`
`sub.sequently
`
`completed
`
`my
`
`residency
`
`training
`
`at
`
`the University
`
`of Arkansas
`
`for Medical
`
`Sciences
`
`Department
`
`of Pathology
`
`from
`
`2001
`
`thru
`
`2007.
`
`I completed
`
`my fellowships
`
`in hematopathology
`
`and
`
`gastrointestinal
`
`During
`
`pathology.
`
`that
`
`time
`
`.During
`
`I had
`
`extensive
`
`in
`
`and molecular
`
`this
`
`time,
`
`training
`
`pulmonary
`
`pathology
`
`which
`
`I have.
`
`continued
`
`to practice
`
`with
`
`special
`
`interest
`
`throughout
`
`pathology,
`
`my
`
`career.
`
`I am
`
`board
`
`certified
`
`in Anatomic
`
`Pathology,
`
`Clinical
`
`Pathology
`
`and
`
`Hematopathology.
`
`I am currently
`
`licensed
`
`to
`
`practice
`
`medicine
`
`in Arkansas,
`
`Alabama,
`
`Mississippi,
`
`Oklahoma,
`
`re-cer+1hah
`
`and
`
`Texas.
`
`I have
`
`been
`
`a licensed
`
`Medical
`
`Review
`
`Officer
`
`since
`
`2009,
`
`with
`
`in
`
`2014.
`
`Since
`
`2007
`
`I have
`
`practiced
`
`with
`
`Pathology
`
`Laboratories
`
`of
`
`Arkansas,
`
`P.A.
`
`As part
`
`of my practice
`
`and
`
`on a daily
`
`basis,
`
`I examine
`
`numerous
`
`tissues,
`
`biopsies.
`
`I review
`
`molecular
`
`analysis
`
`types
`
`including
`
`tumor
`
`types
`
`and
`
`lurig
`
`of numerous
`
`of
`
`pathology
`
`specimens,
`
`both
`
`tissue
`
`and
`
`blood,
`
`including
`
`molecular
`
`analysis
`
`of
`
`lung
`
`cancer
`
`and mesothelioma.
`
`I am the medical
`
`director
`
`for multiple
`
`laboratories
`
`including
`
`the
`
`largest
`
`c.Iiñical
`
`laboratory
`
`in the
`
`state
`
`of Arkansas,
`
`the Baptist
`
`Health
`
`Medical
`
`Center
`
`in
`
`Little
`
`Rock.
`
`During
`
`my
`
`career,
`
`I have
`
`reviewed
`
`hundreds
`
`of
`
`cases
`
`of
`
`asbestosis,
`
`asbestos
`
`related
`
`pleural
`
`disease,
`
`lung
`
`carcinomas
`
`and mesotheliomas,
`
`both
`
`in
`
`clinical
`
`practice
`
`and
`
`in the
`
`setting
`
`of medical
`
`legal
`
`consultation.
`
`I have
`
`performed
`
`more
`
`than
`
`a
`
`thousand
`
`diseases.
`
`autopsies,
`
`which
`
`included
`
`individuals
`
`who
`
`suffered
`
`from
`
`asbestos-related
`
`My qualifications
`
`are
`
`further
`
`described
`
`in my Curriculum
`
`Vitae
`
`(Exhibit
`
`1).
`
`I hold
`
`based
`
`the
`
`following
`on my personal
`
`opinions
`
`to a reasonable
`
`degree
`
`of medical
`
`and
`
`scientific
`
`training,
`
`experience,
`
`knowledge,
`
`and
`
`expertise,
`
`as well
`
`certainty
`as relevant
`
`literature,
`
`articles,
`
`studies,
`
`documents,
`
`and
`
`medical
`
`and
`
`scientific
`
`principles.
`
`methodology
`
`and
`
`basis
`
`for
`
`these
`
`opinions
`
`are
`
`generally
`
`accepted
`
`in
`
`the medical
`
`The
`
`and
`
`scientinc
`
`community.
`
`While
`
`I do
`
`not
`
`agree
`
`with
`
`every
`
`position
`
`or
`
`statement
`
`of
`
`each
`
`1
`
`

`

`FILED: NEW YORK COUNTY CLERK 07/17/2019 09:27 AM
`NYSCEF DOC. NO. 253
`
`INDEX NO. 190194/2017
`
`RECEIVED NYSCEF: 07/17/2019
`
`document
`
`or
`
`reference
`
`cited,
`
`the
`
`materials
`
`and
`
`information
`
`discussed
`
`below
`
`are
`
`appropriate
`
`and
`
`sufficient
`
`to form
`
`a reliable
`
`basis
`
`for my
`
`opinions.
`
`These
`
`are
`
`the
`
`types
`
`of
`
`foundational
`
`materials
`
`that
`
`I, as well
`
`as other
`
`medical
`
`doctors
`
`rely
`
`upon
`
`in our
`
`and
`
`standard
`
`practice
`
`of medicine
`
`to
`
`formulate
`
`opinions
`
`outside
`
`the
`
`medical
`
`consulting
`
`context.
`
`This
`
`affidavit
`
`may
`
`be
`
`submitted
`
`in
`
`litigation
`
`to
`
`accompany
`
`daily
`
`legal
`
`case-
`
`specific
`
`medical
`
`reports
`
`and/or
`
`for
`
`general
`
`disclosures
`
`as a basi.s
`
`for my
`
`opinions
`
`and
`
`This
`
`does
`
`nor
`
`is it
`
`intended
`
`state
`
`all
`
`opinions
`
`methodcicgy.
`
`affidavit
`
`not,
`
`to,
`
`of my
`
`or
`
`all
`
`of
`
`the
`
`supporting
`
`materials
`
`on
`
`the
`
`related
`
`subject
`
`matter.
`
`Principles
`
`of Asbestos
`
`Related
`
`Diseases
`
`1. Asbestos
`
`·is a term
`
`used
`
`to
`
`describe
`
`two
`
`families
`
`of naturally-occurring
`
`fibrous
`
`minerals,
`
`serpentine
`
`(chrysotile)
`
`and
`
`amphibole
`
`(actinalite,.
`
`amosite,
`
`anthophyllite,
`
`crocidolite
`
`and
`
`tremolite).
`
`Asbestos
`
`was
`
`mined
`
`for
`
`commercial
`
`purposes
`
`in
`
`Canada,
`
`South
`
`Africa,
`
`Italy,
`
`Australia,
`
`Rhodesia,
`
`Russia,
`
`United
`
`States,
`
`and
`
`other
`
`countries,
`
`starting
`
`in
`
`the
`
`late
`
`1800's.
`
`The
`
`list
`
`of
`
`commercial
`
`uses
`
`for
`
`asbestos
`
`grew
`
`so
`
`that
`
`the
`
`uses
`
`were
`
`summarized
`
`into
`
`long
`
`by
`
`1972,
`
`broad
`
`areas
`
`consisting
`
`of
`
`construction,
`
`floor
`
`tile,
`
`friction
`
`materials,
`
`asphalt
`
`felts,
`
`packing
`
`Ji,
`
`and
`
`D.H.K.
`
`Lee.
`
`and
`
`A*stos
`
`gaskets,
`
`insulation,
`
`tedes;
`
`and
`
`other.
`
`Selikoff,
`
`and
`
`Disease.
`
`Academic
`
`Press,
`
`NY,
`
`1978.
`
`paper,
`
`Irving
`
`2.
`
`Asbestos
`
`disease
`
`in humans
`
`was
`
`described
`
`in reports
`
`in many
`
`countries
`
`as early
`
`as
`
`an
`
`the
`
`late
`
`1890's
`
`through
`
`the
`
`1920's.
`
`In
`
`1930 Merewether
`
`and
`
`Price
`
`published
`
`official
`
`government
`
`investigative
`
`report
`
`of
`
`conditions
`
`and
`
`health
`
`problems,
`
`including
`
`asbestosis,
`
`related
`
`to
`
`the
`
`asbestos
`
`industry
`
`in England.
`
`Merewether
`
`then
`
`published
`
`findings
`
`a lengthy
`
`report
`
`of his
`
`in
`
`the United
`
`States
`
`in
`
`the
`
`same
`
`year.
`
`Merewether,
`
`E.R.A.
`
`The
`
`Occurrence.
`
`of Pulmonary
`
`Fibrosis
`
`and
`
`Other
`
`Pu1rnonary
`
`Affections
`
`in Asbestos
`
`Workers.
`
`J.
`
`Indust.
`
`Hyg.
`
`(1930).
`
`Castleman,
`
`B., Asbestos
`
`Medical
`
`and
`
`Legal
`
`Aspects,
`
`12:198-222,
`55 Ed.,
`
`239-257
`
`2004.
`
`3.
`
`Asbestos
`
`was
`
`and
`
`1940's.
`
`causally
`
`Lynch,
`
`linked
`
`to cancer,
`
`starting
`
`with
`
`case
`
`reports,
`
`in
`
`the
`
`1930's
`
`K. M.
`
`and
`
`W.
`
`Atmar
`
`Smith.
`
`Palmonary
`
`Asbestosis
`
`17T:
`
`Carcinoma
`
`of Lung
`
`in Asbestos-Silicosis.
`
`Am.
`
`J. Cancer.
`
`24:56
`
`(1935).
`
`In
`
`1949,
`
`additional
`
`references
`
`implicated
`
`asbestos
`
`as
`
`a cause
`
`of
`
`cancer.
`
`Asbestosis
`
`and
`
`2
`
`

`

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`
`INDEX NO. 190194/2017
`
`RECEIVED NYSCEF: 07/17/2019
`
`Cancer
`
`of
`
`the
`
`Lung,
`
`The
`
`Journal
`
`of
`
`the
`
`American
`
`Medical
`
`Association
`
`(JAMAL
`
`Vol.140,
`
`No.
`
`15, pp.
`
`1219-20
`
`(1949);
`
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`
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`
`and
`
`Lung
`
`Cancer,
`
`Compensation
`
`Medicine,
`
`Nov
`
`(1949);
`
`Conklin,
`
`G.,
`
`Cancer
`
`and
`
`Environment,
`
`Scientific
`
`American,
`
`Vol.
`
`180,
`
`No.
`
`1, Jan
`
`(1949).
`
`By
`
`the
`
`1950's,
`
`asbestos
`
`was
`
`well-knowT1
`
`and
`
`accepted
`
`as
`
`a cause
`
`of
`
`cancer.
`
`Doll,
`
`R. Mortality
`
`from
`
`Lung
`
`Cancer
`
`Med.
`
`(2):81-86(1955).
`
`in Asbestos
`
`Workers.
`
`Br.
`
`J.
`
`Ind.
`
`12
`
`In
`
`addition,
`
`mesothelioma
`
`was
`
`reportedly
`
`caused
`
`by
`
`asb.estos
`
`in
`
`a number
`
`of
`
`sources
`
`in
`
`the
`
`1950's.
`
`The
`
`fact
`
`that
`
`asbestos
`
`caused
`
`during
`
`the
`
`1960's.
`
`For
`
`discussion,
`
`mesothelioma
`See Whff
`
`was
`
`firmly
`
`established
`
`Irving
`
`J.,
`
`and
`
`D.H.K.
`
`Lee.
`
`Asbestos
`
`and
`
`Disease.
`
`Medical
`
`and
`
`Legal
`
`Aspects,
`
`Academic
`5± Ed.,
`
`Press,
`
`NY,
`
`1978,
`
`2004.
`
`Chapter
`
`and
`
`Ca9lerrian,
`2 - Cancer.
`
`B., Asbestos
`
`4.
`
`and
`
`complete
`
`and
`
`Asbestos
`
`is a known
`
`carcinogen,
`
`so it both
`
`initiates
`
`promotes
`
`cancer.
`
`It has
`
`been
`
`demonstrated
`
`for
`
`decades
`
`through
`
`scientific
`
`study
`
`that
`
`the
`
`inhalation
`
`of asbestos
`
`fibers
`
`of all
`
`fiber
`
`types
`
`causes
`
`mesothelioma,
`
`lung
`
`cancer,
`
`as well
`
`as
`
`cancer
`
`of
`
`other
`
`sites.
`
`In
`
`addition
`
`to
`
`cancer,
`
`asbestos
`
`causes
`
`non-
`
`malignant
`
`diseases
`
`including
`
`eshestosis,
`
`pleural
`
`fibrosis,
`
`and
`
`pleural
`
`plaques.
`
`The
`
`for
`
`all
`
`types
`
`of
`
`asbestos
`
`(amphibole,
`
`chrysotile,
`
`as well
`
`as
`
`non-
`
`ability
`
`commercial
`
`asbestifonn
`
`mineral
`
`fibers)
`
`to
`
`cause
`
`cancers
`
`and
`
`non-malignant
`
`disease
`
`is
`
`overwhelmingly
`
`accepted
`
`and
`
`agreed
`
`to
`
`by
`
`the medical
`
`and
`
`scientific
`
`community.
`
`publications,
`
`This
`
`scientific
`
`consensus
`
`is
`
`reflected
`
`and
`
`the
`
`references
`
`contained
`
`therein,
`
`upon
`
`in many
`I
`
`which
`
`sources
`
`and
`
`rely,
`
`including:
`
`•
`
`•
`
`•
`
`•
`
`•
`
`Profile
`for Asbestos.
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`Health
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`2001.
`Thoracic
`related
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`IARC.
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`
`for
`
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`
`U.S.
`
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`
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`K, Woitowitz
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`a
`
`3
`
`

`

`FILED: NEW YORK COUNTY CLERK 07/17/2019 09:27 AM
`NYSCEF DOC. NO. 253
`
`INDEX NO. 190194/2017
`
`RECEIVED NYSCEF: 07/17/2019
`
`•
`
`•
`
`•
`
`•
`
`•
`
`•
`
`•
`
`•
`
`•
`
`•
`
`•
`
`•
`
`•
`
`•
`
`•
`
`•
`
`•
`
`•
`
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`
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`
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`4
`
`

`

`FILED: NEW YORK COUNTY CLERK 07/17/2019 09:27 AM
`NYSCEF DOC. NO. 253
`
`INDEX NO. 190194/2017
`
`RECEIVED NYSCEF: 07/17/2019
`
`982.
`Sci.
`160-176
`N.Y.
`Acad.
`Suzuki,
`(2002];
`ofhuman
`development
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`contribute
`fibers
`evidence.
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`pathological
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`Production
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`Peritoneal
`to Malignant
`Linked
`of 28 Cases
`in Southeast
`China,
`(2015).
`
`of
`
`and
`
`•
`
`5.
`
`Asbestos
`
`shows
`
`a linear
`
`dose-response
`
`relationship
`
`with
`
`regard
`
`to
`
`the
`
`risk
`
`developing
`
`mesothelioma,
`
`lung
`
`cancer
`
`and
`
`non-malignant
`
`asbestos
`
`diseases.
`
`of
`
`It
`
`is demonstrated
`
`in multiple
`
`studies
`
`that
`
`the more
`
`asbestos
`
`a person
`
`is exposed
`
`to
`
`over
`
`time,
`
`the
`
`higher
`
`the
`
`risk
`
`of developing
`
`an
`
`asbestos
`
`related
`
`disease.
`
`See
`
`above
`
`references;
`
`see
`
`also
`
`Pitot,
`
`Pundamentàls
`
`of Oncology;
`
`45
`
`Ed,
`
`Marcel
`
`NY,
`
`2002.
`
`This
`
`risk
`
`is related
`
`to the
`
`cumulative
`
`dose
`
`of asbestos
`
`inhaled
`
`Dekker,
`
`over
`
`and
`
`all
`
`time,
`dose. When more
`
`doses
`
`(small
`
`and
`
`large)
`
`of asbeetoe
`
`contribute
`
`to the
`
`cumulative
`
`asbestos
`
`fibers
`
`are
`
`inhaled,.more
`
`asbestos
`
`fibers
`
`overcome
`
`the
`
`body's
`
`defense
`
`mechanisms,
`
`which
`
`increases
`
`the
`
`risk
`
`and
`
`causes
`
`an
`
`asbestos
`
`disease(s)
`
`in
`
`some
`
`individuals.
`
`6. When
`
`asbestos
`
`is
`
`inhaled,
`
`a portion
`
`of asbestos
`
`fibers
`
`are
`
`retained
`
`in
`
`the
`
`lungs
`
`and
`
`others
`
`are
`
`translocated
`
`to other
`
`sites
`
`where
`
`disease
`
`develops.
`
`Miserocchi
`
`et
`
`al.,
`
`Translocation
`
`pathways
`
`for
`
`inhaled
`
`asbestos
`
`Jibers,
`
`Environ.
`
`Health
`
`7:4;1-8
`
`cause
`
`(2008).
`
`Mesothclisma
`
`occurs
`
`when
`
`asbestos
`
`fibers
`
`multiple/sufficient
`
`genetic
`
`errors
`
`in mesothelial
`
`cells
`
`around
`
`the
`
`heart
`
`(pericardium),
`
`or
`
`the
`
`the.
`
`lungs
`
`(pleural,
`
`the
`
`abdomen
`
`reproductive
`
`.organs
`
`(tunica
`
`(peritoneal),
`
`vagin*lis).
`
`All
`
`types
`
`of asbestos
`
`induce
`
`genetic
`
`errors.
`
`Kamp,
`
`D.W.
`
`Asbestos-
`
`induced
`
`lung
`
`diseases:
`
`an
`
`update.
`
`Translational
`
`Res.
`
`153:
`
`143-152,
`
`2009.
`
`Hei,
`
`T.K.
`
`et al.
`
`Chrysotile
`
`is a strong
`
`mutagen
`
`in mammalian
`
`cells.
`
`Cancer
`
`Res.
`
`52:
`
`6305-9,
`
`1992.
`
`Harris,
`
`C.C.,
`
`Lechner,
`
`J.G.
`
`and
`
`Brinkley,
`
`B.R.,
`
`Cellular
`
`and
`
`Molecular
`
`Aspects
`
`of Fiber
`
`Carcinogenesis.
`
`Cold
`
`Spring
`
`Harbor
`
`Lab
`
`Press,
`
`NY,
`
`1991.
`
`It
`
`often
`
`takes
`
`many
`
`decades
`
`(latency
`
`period)
`
`for
`
`a sufficient
`
`number
`
`of
`
`genetic
`
`errors
`
`to result
`
`which
`
`destroy
`
`defective
`
`in
`
`a mesothelioma,
`cells.
`
`as
`
`the
`
`body
`
`has
`
`defense
`
`mechanisms
`
`7.
`
`1 am in
`
`agreement
`
`with
`
`the
`
`methodology
`
`discussed
`
`and
`
`employed
`
`by
`
`IARC,
`
`ATSDR
`
`and
`
`others,
`
`which
`
`includea
`
`looking
`
`at all
`
`available
`
`evidence
`
`regarding
`
`dangers
`
`of
`
`asbestos.
`
`This
`
`weight
`
`of
`
`evidence
`
`approach
`
`is
`
`consistent
`
`with
`
`the
`
`the
`
`5
`
`

`

`FILED: NEW YORK COUNTY CLERK 07/17/2019 09:27 AM
`NYSCEF DOC. NO. 253
`
`INDEX NO. 190194/2017
`
`RECEIVED NYSCEF: 07/17/2019
`
`Bradford
`
`Hill
`
`Criteria
`
`that
`
`is often
`
`referenced,
`
`as well
`
`as Dr.
`
`Lemen's
`
`application.
`
`Lemen,
`
`R.A.,
`
`Chrysotile
`
`Asbestos
`
`as a Cause
`
`of Mesothelioma:
`
`Application
`
`of
`
`the
`
`Hill
`
`Causation
`
`Model,
`
`Int.
`
`J Occup
`
`Environ
`
`Health,
`
`Vol.
`
`10,
`
`No.2,
`
`Apr/June
`
`2004.
`
`8.
`
`All
`
`governmental
`
`and
`
`authoritative
`
`agencies
`
`have
`
`reviewed
`
`appropriate
`
`scientific
`
`studies
`
`and
`
`literature
`
`and
`
`all
`
`have
`
`determined
`
`that
`
`there
`
`is no
`
`safe
`
`level
`
`(threshold)
`
`of asbestos
`
`exposure
`
`below
`
`which
`
`there
`
`is no
`
`risk
`
`of cancer.
`
`government
`
`regulations
`
`are
`
`nor
`
`were
`
`Aebeetee
`
`exposure
`
`limits
`
`allowed
`
`by
`
`not,
`
`they
`
`intended
`
`to be protective
`
`of cancer.
`
`See
`
`referenced
`
`sources,
`
`including
`
`EPA,
`
`NIOSH,
`
`USPHS,
`
`OSHA,
`
`and WHO.
`
`Rather,
`
`these
`
`allowances
`
`are
`
`a
`
`compromise
`
`between
`
`industry
`
`feasibility,
`
`industry
`
`resistance
`
`to asbestos
`
`regulations,
`
`and
`
`the
`
`protective
`
`goals
`
`of
`
`the
`
`agencies..
`
`The
`
`scientific
`
`community
`
`knows
`
`that
`
`exposure
`
`to asbestos
`
`at
`
`the
`
`regulatory
`
`levels
`
`will
`
`result
`
`in
`
`excess
`
`cancers.
`
`9.
`
`The
`
`potency
`
`of
`
`fiber
`
`types
`
`to cause'mesothelioma
`
`and
`
`lung
`
`cancer
`
`is an
`
`issue.
`
`studies
`
`between
`
`unsettled
`
`Numerous
`
`have
`
`reported
`
`potency
`
`differences
`
`chrysotile
`
`and
`
`amphiboles
`
`and many
`
`theories
`
`and
`
`explanations
`
`exist.
`
`Markowitz
`
`SB,
`
`2015.
`
`The
`
`IARC
`
`Monograph
`
`on
`
`asbestos
`
`from
`
`2012
`
`reported
`
`there
`
`is a high
`
`degree
`
`of uncertainty
`
`concerning
`
`the
`
`accuracy
`
`of
`
`the
`
`relative
`
`potency
`
`estimates
`
`derived
`
`from
`
`the Hodgson
`
`& Darnton
`
`and
`
`Berman
`
`& Crump
`
`analyses.
`
`Further
`
`complicating.the
`
`issue
`
`is mixed-fiber
`
`exposure,
`
`which
`
`regularly
`
`Toxicology,
`
`occurs
`
`in individuals
`
`with
`
`asbestos
`
`caused
`
`cancer.
`
`See
`
`also,
`
`Patty's
`
`Sixth
`
`Ed.
`
`Vol S. Chapter
`
`83.
`
`John
`
`Wileý
`
`& Sons,
`
`2012.
`
`10. Mesothelioma
`
`is a rare
`
`and
`
`fatal
`
`cancer,
`
`occuning
`
`in
`
`only
`
`approximately
`
`3,000
`
`persons
`
`per
`
`year
`
`in the United
`
`States.
`
`The
`
`relationship
`
`between
`
`mesothelioma
`
`exposure
`
`to asbestos
`
`is so well
`
`mesothelioma
`
`is
`
`considered
`
`a "signal
`
`established
`tumor"
`
`in the
`
`scientific
`
`community,
`
`for
`
`asbestos
`
`exposure.
`
`See
`
`Reference
`
`Manual
`
`on Scientific
`
`Evidence,
`
`Federal
`
`Judicial
`
`Center
`
`1994
`
`and
`
`and
`
`that
`
`also,
`
`2000
`
`Editions,
`
`p. 351,
`
`"There
`
`are
`
`some
`
`diseases
`
`that
`
`exposure
`
`to an
`
`agent;
`
`these
`
`are
`
`known
`
`as
`
`signature
`
`6
`
`do not
`diseases."
`
`occur
`
`without
`
`See
`
`also
`
`Shy,
`
`

`

`FILED: NEW YORK COUNTY CLERK 07/17/2019 09:27 AM
`NYSCEF DOC. NO. 253
`
`INDEX NO. 190194/2017
`
`RECEIVED NYSCEF: 07/17/2019
`
`Greenberg,
`
`Winn,
`
`Sentinel
`
`Health
`
`Events
`
`of Environmental
`
`Contamination:
`
`A
`
`Consensus
`
`Statement,
`
`Nov.
`
`1, 1989;
`
`ATSDR,
`
`Case
`
`Studies
`
`in Environmental
`
`Medicine:
`
`Asbestos
`
`Toxicity,
`
`Rev.
`
`Nov.
`
`2000.
`
`Thus
`
`if a person
`
`has
`
`mesothelioma,
`
`it mignals
`
`that
`
`they
`
`likely
`
`had
`
`prior
`
`asbestos
`
`exposure,
`
`even
`
`if
`
`they
`
`are
`
`not
`
`aware
`
`of
`
`such
`
`exposures
`
`or do not
`
`remember
`
`them
`
`from many
`
`years
`
`earlier.
`
`It
`
`is also
`
`possible
`
`that
`
`upon
`
`biopsy
`
`or autopsy,
`
`no
`
`asbestos
`
`fibers
`
`are
`
`found,
`
`yet
`
`asbeetoe
`
`fibers
`
`were
`
`which
`
`caused
`
`genetic
`
`errors
`
`leading
`
`to mesothelioma.
`
`previously
`
`present,
`
`11.It
`
`has
`
`been
`
`established
`
`that
`
`household/take-home
`
`and
`
`neighborhood
`
`exposures
`
`cause
`
`mesothelioma.
`
`See
`
`supra
`
`para
`
`4, and
`
`