EXPERT REPORT 

 OF 

 NORMAN I. KLEIN MD 

 Clinical Assistant Professor of Medicine 

 NYU Langone Medical Center

 Kelsey Cascadia Rose Juliana; Xiuhtezcatl Tonatiuh M., 

through his Guardian Tamara Roske-Martinez; et al., Plaintiffs,

 v. 

 The United States of America; Donald Trump, in his official 

capacity as President of the United States; et al.,

 IN THE UNITED STATES DISTRICT COURT

 DISTRICT OF OREGON

 (Case No. 6:15-cv-01517-TC)

 Prepared for Defendant and Attorneys for Defendant

Case 6:15-cv-01517-AA Document 338-6 Filed 08/24/18 Page 1 of 10
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I, Norman I. Klein MD, have been retained by the Defendants in the 

above cited case, to provide expert opinion and testimony, regarding

the allegations of respiratory health issues set forth in Plaintiffs’ 

complaint and Plaintiffs’ individual declarations, as well as Plaintiffs’ 

and Plaintiffs’ experts’ discussion of the relationship between those 

alleged respiratory health issues and climate change. I am being 

compensated for my work at the rate of $375 per hour, with a $3,000 

fee for half-day or $5,500 fee for full-day deposition testimony or court 

appearance. My payment is not contingent on the outcome of this—or 

any other—litigation.

I am board certified in Pediatrics and in Allergy Immunology. I have 

been practicing medicine with a focus on treating asthma and other 

respiratory diseases in children, adolescents and adults since 1976. I 

have had numerous teaching and academic positions during this time. 

in preparing this report, I reviewed the following documents:

1. The first amended Complaint (ECF No. 7)

2. Declaration of Dr. Hansen and accompanying exhibits 

3. The article attached as Exhibit 3 to Plaintiffs’ complaint (ECF No. 

7-4).

4. Declarations in support of Plaintiffs’ motion for summary 

judgement

5. Expert reports of:

a. Dr. Frumkin

b. Dr. Van Susteren

c. Drs. Pacheco and Paulson

I understand that discovery in this case is ongoing. To the extent 

relevant materials or testimony is revealed during the course of those 

discovery efforts, I reserve my right to amend this report, as 

appropriate.

Case 6:15-cv-01517-AA Document 338-6 Filed 08/24/18 Page 2 of 10
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I have been asked to opine on whether Plaintiffs’ expert reports, 

specifically the reports from Drs. Frumkin, Pacheco, and Paulson 

(collectively, “Expert Reports”), establish a causal connection between 

the harms the individual Plaintiffs complain of and climate change. The 

reports are, in essence, a recap of statistics, probability, and predictions

of a global nature. With respect to the focus of this report (i.e., 

respiratory ailments like asthma and allergies), Drs. Frumkin, Paulson, 

and Pacheco overgeneralize and refocus the broader abstract analyses 

cited in the Expert Reports and apply those analyses to the specific 

claims of harm documented in the Complaint and in the Plaintiffs’ 

individual declarations 

In order to assess the soundness of the Expert Reports’ direct 

application of (1) general risk studies and general probabilities that 

climate change can increase the risks of, among other things, asthma 

and allergies to (2) the specific complaints of asthma and allergies set 

forth in Plaintiffs’ complaint and declarations, medical professionals 

must determine if those conditions apply to a particular individual 

patient’s symptoms and condition at the time of the visit, as opposed to 

a theoretical , and by ruling in or out other predisposing circumstances 

or cause. When I see a patient in my office, a complete, detailed 

history is taken to document triggers and possible triggers for their 

allergy or asthma symptoms. The exact symptoms, severity, location, 

and timing are determined, as accurately as possible, to attempt to 

document specific causation for the particular incident, as well as the 

condition in general. This is followed by a complete physical 

examination. Testing for allergens and for pulmonary function would 

then be done as indicated for each specific individual. Getting an 

individual’s specific causation or trigger factor(s) identified allows for 

more effective targeted therapy. This way, prescribed life style or 

environmental changes and medications will be most effective.

Case 6:15-cv-01517-AA Document 338-6 Filed 08/24/18 Page 3 of 10
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As a threshold matter, a medical professional would not simply 

rely on a complaint or a declaration filed in a lawsuit to establish 

asthma and/or allergy symptoms. In order to confirm that these 

symptoms are, in fact, experienced, a medical professional would take 

the examination steps outlined in the preceding paragraph. 

Even if the individual Plaintiffs’ complaints of allergy and asthma 

symptoms were credited, an examination of other potential 

contributing factors must be evaluated before climate change could be 

determined as a contributing, much less primarily contributing, factor 

to these specific Plaintiffs. Asthma, like many medical conditions, is 

multi factorial. Genetics plays an even larger role than does 

environment. There are a number of theories for triggering asthma. For 

example, the Hygiene Hypothesis suggests living conditions in much of 

the world have become too (bacteriologically) clean, so children aren’t 

being exposed to germs that train their immune systems to 

differentiate between harmless and harmful substances. This 

Hypothesis finds support in, among other observations, the fact that

children growing up on farms who are exposed to more bacterial 

endotoxin have less allergies than their urban counterparts. In addition, 

there is research suggesting that early antibiotic usage, changes 

bacterial flora impacting development of allergies. Also, the increased 

use of Acetaminophen (Tylenol) may have an impact on increased risk 

for allergies and asthma. Moreover, lifestyle and diet changes that lead

to obesity have been suggested by many experts to increase asthma 

prevalence. Vitamin D deficiency from excessive time indoors with 

inadequate sunlight exposure has also been suggested as a likely 

Case 6:15-cv-01517-AA Document 338-6 Filed 08/24/18 Page 4 of 10
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causative factor. Finally, the number one trigger of asthma 

exacerbation is viral infection, particularly influenza. 1

Similarly, other respiratory allergies also have contributing factors 

that do not concern climate change. Many of the same risk and cause 

factors for asthma apply to Allergic Rhinitis. For example, Genetics is 

again of prime importance, as are the Hygiene Hypothesis and viral 

infection.2 

By not evaluating these and other factors and focusing only on a 

single possible trigger for the asthma and allergy symptoms set forth in 

the complaint and in Plaintiffs’ declarations, Drs. Frumkin, Pacheco, and 

Paulson offer an incomplete and, therefore, misleading explanation for 

the relationship between those declarations and climate change. There 

are no medical reports, test results, ER or hospital visits, or in fact any

objective documentation of any kind in the Plaintiff’s complaint. By way 

of example, Plaintiffs’ complaint alleges, “Additionally, Alex is allergic to 

pollen and suffers worse in unseasonably warm years. He also suffers 

from asthma, which is worse in the increasingly smoky summer 

months. Alex’s allergies and asthma will worsen as climate change 

caused by defendants worsens.” (Complaint ¶ 28.) To substantiate 

these allegations, a medical professional should review medical 

records, examine Alex, and explore alternative explanations beyond 

Defendants’ actions. In the absence of this data, I see no reliable basis 

for substantiating these allegations or the allegation’s conclusion that 

 

1 Guidelines for the Diagnosis and Management of Asthma pp.22-23, 48-50, 165-89; Figs. 3-1, 3-

2, 3-17 (available at https://www.nhlbi.nih.gov/sites/default/files/media.docs/asthgdln_1.pdf).

2 A general discussion of these factors can be found at J Allergy Clin Immunol. 2001 Nov; 108 (5 

Suppl): S147-334, as well as https://www.jacionline.org/article/S0091-6749(11)01158-4/fulltext

and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1661616/.

Case 6:15-cv-01517-AA Document 338-6 Filed 08/24/18 Page 5 of 10
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“Alex’s specific allergies and asthma will worsen as climate change 

caused by defendants worsen.”

In conclusion, Drs. Frumkin, Pacheco, and Paulson confuse general 

correlations from abstract epidemiological studies with clinical 

examination of specific instances of asthma and allergy symptoms. One 

cannot tie a specific instance of allergies or asthma to climate change 

without a specific evaluation of the patient and an examination of all 

potential contributors to allergies/asthma. Because Drs. Frumkin, 

Pacheco, and Paulson did not conduct the necessary evaluation and/or

analysis to tie the abstract studies they rely on to the specific symptoms 

set forth in the complaint and in the Plaintiffs’ declarations, I opine that 

the conclusions Drs. Frumkin, Pacheco, and Paulson reach concerning 

the role that climate change has had on the specific instances of 

asthma and allergy complaints by the specific Plaintiffs in this case to be 

unreliable.

Respectfully submitted,

Norman I. Klein, MD

August 13, 2018

 

Case 6:15-cv-01517-AA Document 338-6 Filed 08/24/18 Page 6 of 10
"Alex's specific allergies and asthma will worsen as di mate d1ange 

caused by defendants worsen." 

In condusion, Ors. Frumkin, Pacheoo, and Paulson confuse general 

correlations from abstract epidemiological studies with dinical 

examination of specific instances of asthma and allergy symptoms. Ole 

cannot tie a specific instance of allergies or asthma to dimate change 

without a specific evaluation of the patient and an examination of all 

potential contributors to allergies'asthma. E3ecause Ors. Frumkin, 

Pacheoo, and Paulson did not conduct the necessary evaluation and/ or 

analysis to tie the abstract studies they rely on to the specific symptoms 

set forth in the complaint and in the Raintiffs' dedarations, I opine that 

the condusions Ors. Frumkin, Pacheoo, and Paulson reach concerning 

the role that dimate change has had on the specific instances of 

asthma and allergy complaints by the specific Raintiffs in this case to be 

unreliable. 

Fe,pectfully submitted, 

. e-4/~p 

Norman I. Klein, MD 

August 13, 2018 

5 

Case 6:15cv01517AA Document 3386 Filed 08/24/18 Page 7 of 10
 NORMAN I. KLEIN, MD

(516) 996-4300 (C)

(718) 382-6821 (Fax)

(718) 347-1004 (O)

Email: 9.nklein@gmail.com

PROFESSIONAL EXPERIENCE

 June 1981- September 2017 

 BROOKDALE UNIVERSITY HOSPITAL AND MEDICAL CENTER, BROOKLYN, NY

 Attending in Charge – Clinical Immunology and Allergy

 June 1981 SUNY HEALTH SCIENCE AT BROOKLYN 

 Assistant Professor of Pediatrics – SUNY

 December 2015 NYU Langone Medical Center

 Clinical Assistant Professor of Medicine 

 June 1981- September 2017

 BROOKDALE UNIVERSITY HOSPITAL AND MEDICAL CENTER, BROOKLYN, NY

 Attending – Department of Pediatrics

 Associate Medical Staff – Department of Medicine

 BROOKLYN HOSPITAL CENTER, BROOKLYN, NY

 Medical Staff – Department of Pediatrics

 July 2014 New York College of Osteopathic Medicine, NY, NY

 Adjunct Clinical Assistant Professor – Department of Pediatrics

 

 July 2014 Ross University School of Medicine

 Clinical Assistant Professor of Pediatrics

 

EDUCATION 

1972 Yeshiva University, New York

Magna Cum Laude - BA Biology

1976 SUNY of New York at Brooklyn

1976 – MD

1976 – 1978 Resident – Pediatrics 

1978 – 1979 Chief Resident - Pediatrics

 The Brookdale University Hospital and Medical Center, Brooklyn, New York 

1979-1981 Fellow - Allergy/Immunology 

Albert Einstein College of Medicine, Bronx, New York 

Case 6:15-cv-01517-AA Document 338-6 Filed 08/24/18 Page 8 of 10
CERTIFICATION & LICENSURE

 

♦ American Board of Allergy & Immunology a conjoint Board of American Board of Internal 

Medicine and American Board of Pediatrics – No. 26397 – Board certified September 1981

♦ American Board of Pediatrics – No. 2399 certified October 1983

♦ New York State License: No. 132880 – October 1977

HONORS/AWARDS

♦ Alpha Epsilon Delta - Pre Medical Honor Society 

♦ NY Magazine “Best Doctors” 2005,2006,2007,2008,2009,2010,2011

♦ US News and World Report “Best Doctors” 2011

♦ New York Times “Super Doctors” 2012, 2013,2014,2015,2016,2017

FELLOWSHIPS AND RESEARCH GRANTS

1) Brookdale University Hospital – Department of Psychiatry, July – August 1975 (summer 

fellowship in adult/child psychiatry under Dr. J. Frosch)

2) SUNY – Health Science Center at Brooklyn – Department of Pulmonary Medicine, July –

August 1973 (summer research from the New York Lung Association “Search for Humeral 

Mediators of Exercise Induced Bronchoconstriction” under Dr. Harold Lyons and Dr. 

Albert Heurich)

3) Human Development Biology Training Grant NIH-T-32HDO 7053, Dr. Henry L. Barnett, 

July 1979 – June 1981

4) Brooklyn Pediatric AIDS Demonstration Project, 8/1/89 – 7/31/92 (sponsoring agencyHRSA)

ORGANIZATIONS AND SOCIETIES

♦ Member and Trustee – Children’s Immunology Research Fund – September 1982 

♦ Brooklyn Pediatric Society – 1981 

♦ Fellow American College of Allergists – June 1985

PUBLICATIONS

1. Goldstein, J., Klein, N.I., and Rubinstein, A. Culture of rabbit tracheal epithelial cells in

monolayer. Amer. Rev. Resp. Dis. Vol.112 No 4, April 1980 p.70

2. Klein, N.I., Goldstein, H. and Rubinstein, A. Construction of a tracheal pouch in the rabbit. I. 

The secretory IGA system of the pouch, Amer. Rev. Resp. Dis. Vol. 121 No. 4, April 1980 p 367.

3. Rubinstein, A., Sicklick, M., Gupta,A., Bernstein, L., Klein, N.I., Acquired Immuno-deficiency with 

T4/T8 ratios in infants born in to promiscuous and Drug-Addicted mothers. JAMA, May 6, 1983, 

Vol 249, No. 17.

4. Goldstein, NH, Klein, N.I. Rubinstein, A., Construction of a Tracheal Pouch in Rabbits lung (1983) 

161:207-211.

5. Seigel, W., Klein, N.I., Fresko, O., Mestel, A., Ulcerations of the large and small intestines 

secondary to cytomegalovirus in a child with acquired immuno-deficiency syndrome – submitted 

for publication. 

6. Lashley, M., Klein, N.I., Case Report: exercise-induced anaphylaxis in a 4-year-old boy, Annals of 

AllergyVol.64, Number 4,April 1990

Case 6:15-cv-01517-AA Document 338-6 Filed 08/24/18 Page 9 of 10
List of Cases in Which Dr. Klein Has Testified 

at Trial or Deposition in the Last Four Years

1) Beard v. Ingram and Bell etal.

Jan. 2 2014

Fink Smith & Carney 34 w. 37th st NY, NY

2nd deposition 

Nov. 24 2015

Deitz Reporting 26 Court St

Brooklyn, NY

2) Amundsen v. Flanagan

Dec. 4 2014

Office of Susan Hand & Associates

One South Bay Ave. 

Islip , NY

3) Murphy v. The Regents of the University of California

Oct. 21 2016

Bee Reporting

55 Maple Ave.

Rockville Centre NY

4) Alexander v. Accentia

Jan 23 2017 

Bee Reporting

55 Maple Ave.

Rockville Centre NY

5) Alexander v. Lemley

June 28 2018

Onondaga County Courthouse

Syracuse, NY

 

Case 6:15-cv-01517-AA Document 338-6 Filed 08/24/18 Page 10 of 10