Medically-Based Enterprise Risk Management
Toxicology
Lethal Level of Blood Alcohol
Challenge:
A college student died of apparent acute alcohol intoxication after participating in a fraternity party. We were asked by the attorney representing the university to provide a toxicological opinion concerning the blood alcohol level.
Solution:
Our physician toxicologist reviewed the facts of the matter and calculated the maximum blood alcohol level preceding the student's death. Because of his experience in emergency medicine and expertise in assessing such matters, he was able to determine that the fraternity brothers of the decedent were not negligent in their actions that night.
Reflection:
Our toxicologist's thorough evaluation of the case facts and circumstances provided valuable information for our client in carrying out discussions for settlement.
Casino Employee Claims Lung Cancer From Secondhand Cigarette Smoke
Challenge:
A casino received a claim from an employee who worked as a card dealer for total disability for lung cancer due to secondhand smoke exposure. We were consulted to review the facts from a toxicological standpoint.
Solution:
Our toxicologist examined the medical records and employment history of the claimant for exposure, latency and temporality. The review indicated that her prior employment offered more potential exposure to cigarette smoke than her short-term employment at the client casino. Further, the size of the tumor indicated that its development began too soon for the known latency period. The case was decided for only partial disability rather than the full permanent disability claimed.
Reflection:
The partial disability decision was made in this workers' compensation case because the client casino was the last place the claimant worked. Our review provided our client the necessary objective data with which to effectively argue the case before the workers' compensation board.
Hazard Materials Explosion
Challenge:
An explosion occurred at a hazardous material plant which stored, treated and recycled chemical wastes, recovered solvents, and blended other wastes for fuel. The explosion released unknown concentrations of acetone, xylene, and t-butyl amine. Several aboveground storage tanks were impacted by the fire which burned for two days. Nine hundred homes were evacuated within a one-half mile radius of the plant, after fire officials and HAZMAT teams responded to the fire. We were asked to address whether the compounds in the air and soot, and/or exposure to metals in the soot and debris resulting from the explosion and subsequent fire posed a potential for current or future public health hazards.
Solution:
Air samples and bulk samples of soot from the ground were analyzed, along with medical claims of individual claimants. Our physician toxicologist determined that although the fire was visually dramatic, the primary acute health effects would have been acute eye and respiratory tract irritation for those with direct exposure. There was no documented medical evidence that any of the claimants experienced such acute health effects. Our physician toxicologist determined that no injuries did occur or would occur as a result of this event. The chemicals found arising from this event, at the monitored levels, would not cause anything more than transient, minor health effects, if any. Additionally, our team provided strategic assistance to our client to show that the opposing medical expert had not properly applied causation methodology and had reached an unsupported, methodologically flawed conclusion. Our physician toxicologist's affidavit provided a substantive objective and scientifically correct basis for our client, who was able to reach a very favorable settlement.
Reflection:
We have demonstrated – in this and numerous other cases – the ability to critically analyze opposing experts' conclusions and correctly identify improper assumptions they have made which lack confirmatory scientific and/or medical evidence. Thus, many opposing experts have been neutralized by our comprehensive understanding of the medico-legal causation requirements.
Worker Exposure to Adhesives and Glue
Challenge:
A drywall hanger alleged that he developed central nervous system problems due to exposure from his use of drywall adhesives which released chemical vapors into the workplace ambient air. The employer asked us to help.
Solution:
We reviewed a NIOSH investigation of the claimant's working conditions, performed an independent medical evaluation (IME), and reviewed the toxicological literature concerning each of the component chemical substances. Our physician toxicologist determined that there was no evidence of any solvent-induced condition or disease confirmed by the following:
- negative neurodiagnostic evaluation and testing,
- no known health effects associated the component chemical substances solvents, and
- the negative findings of the NIOSH study of his workplace
Based on these findings, we were able conclude and opine that we found no medical or scientific evidence that the claimant had any of the well-delineated, expected neurological findings associated with solvent exposure. Our client was able to settle the matter favorably prior to trial.
Reflection:
Because of our toxicological expertise, we effectively demonstrated that there was no scientific, medical or toxicological support for the claim of any problem causally associated with exposures the claimant might have experienced in his workplace.
Other Case Studies