Opinion ID: 3009922
Heading Depth: 3
Heading Rank: 4

Heading: Monitoring and testing procedures

Text: exist which make the early detection and treatment of the disease possible and beneficial. Id. We stated that these factors must be proven by competent expert testimony. Id. (citation omitted). We did not, however, define the term significantly exposed or state what details an expert must testify to in order to establish it. We recently revisited this issue in In re Paoli Railroad Yard PCB Litigation, 35 F.3d 717 (3d Cir. 1994), (Paoli II), cert. denied, General Electric Co. v. Ingram, 1995 WL 75508 (Feb. 27, 1995) . There, we noted a New Jersey Supreme Court decision which held that plaintiffs seeking recovery for medical monitoring must 'have . . . experienced direct and hence discrete exposure to a toxic substance[.]' Id. at 787 (quoting Theer v. Philip Carey Co., 628 A.2d 724, 733 (N.J. 1993)). Theer held a plaintiff who was exposed to asbestos while laundering her husband's clothes could not bring a medical monitoring claim because, in part, it was too difficult to quantify her exposure. Id. We noted our uncertainty regarding the impact of Theer, but believed Pennsylvania courts would not adopt such a narrow view of the cause of action. We reasoned that [s]omeone indirectly exposed to one chemical might have as much risk of disease as someone directly exposed to another chemical[.] Id. at 787-88. Accordingly, we declined to adopt a per se rule requiring direct exposure, actual injury, and testimony about an individual's particular level of exposure. Id. at 788. Nevertheless, we predicted that the Pennsylvania Supreme Court would set some limits on a medical monitoring claim, and we therefore adopted the Utah Supreme Court's holding in Hansen v. CCI Mechanical, Inc., 858 P.2d 970, 980 (Utah 1993). We stated that: In order for a plaintiff to show significant exposure that causes a significantly increased risk to plaintiff of contracting a serious disease that makes periodic testing reasonably necessary, we think that a plaintiff must: prove that by reason of the exposure to the toxic substance caused by the defendant's negligence, a reasonable physician would prescribe for her or him a monitoring regime different from the one that would have been prescribed in the absence of that particular exposure. This is because under this cause of action, a plaintiff may recover only if the defendant's wrongful acts increased the plaintiff's incremental risk of incurring the harm produced by the toxic substance enough to warrant a change in the medical monitoring that otherwise would be prescribed for that plaintiff. Hansen v. CCI Mech., Inc., 858 P.2d 970, 980 (Utah 1993). The court continued: [I]f a reasonable physician would not prescribe it for a particular plaintiff because the benefits of the monitoring would be outweighed by the costs, which may include, among other things, the burdensome frequency of the monitoring procedure, its excessive price, or its risk of harm to the patient, then recovery would not be allowed. Id. at 788. Significant exposure, therefore, refers to an exposure which, either by duration or harm, is sufficient to cause a significantly increased risk, which in turn is sufficient to require a monitoring regime different from that normally required in the absence of such an exposure. Here, in order to establish the first Paoli I factor of significant exposure, the district court reasoned that plaintiffs must show by clear evidence that they were actually exposed to toxins. The district court noted that [t]here is, of necessity, a degree of speculation in a medical monitoring case. However, . . . the allowable conjecture should be in regard to the amount or future effect of the exposure, not whether there was exposure at all. Redland Soccer Club Inc. v. Dep't of Navy, No. 90-1072, slip op. at 14-15 (M.D. Pa. Oct. 19, 1993). After reviewing plaintiffs' expert reports, the district court concluded that nowhere did plaintiffs' experts unequivocally state that plaintiffs had actually been exposed to any of the toxins alleged to be in the Park's soils or that any of the toxins had actually entered any of the plaintiffs' bodies. The district court's conclusion was based on plaintiffs' failure to present any evidence that the surface soils of the Park contained a level of contamination harmful to human beings. The district court's analysis focuses perceptively on an issue we believe is central in all toxic tort cases; namely, the requirement that the alleged wrong create some significant risk of harm to the plaintiff. Thus, a plaintiff must not only show exposure, but must prove that he was exposed beyond what would normally be encountered by a person in everyday life, so that the plaintiff's risk of being injured from the exposure is greater, in some way, than the normal risks all of us encounter in our everyday lives. In Paoli II, we chose not to delve into the issues of how much exposure there had to be to equal significant exposure, nor how direct the exposure must be. Instead, we simply required the plaintiff to prove indirectly the nature of the exposure by requiring him to show an injury (e.g., a need for medical monitoring greater than that what is required by all persons).8 We do not believe, however, that the Redland FTCA Plaintiffs' failure to produce evidence, in the form of blood or tissue tests, showing directly that they absorbed toxins from the field into their bodies is fatal to their claims. Defendants' own expert stated generally that there are no medical tests which 8 . The injury requirement is particularly important before a remedy such as medical monitoring is provided because the plaintiff's injury is only an increased possibility of harm rather than actual harm. Paoli II's requirement of special medical monitoring implicitly recognizes the longstanding requirement in all tort cases other than those based on the old intentional common law torts for various forms of trespass that a plaintiff must prove an injury before he may recover anything from a defendant. See Gideon v. Johns-Manville Sales Corp., 761 F.2d 1129, 1136 (5th Cir. 1985) (An actionable tort, whether based on negligence or strict liability consists of two elements: a failure to act in accordance with the standard of care required by law and a resultant injury . . . . However egregious the legal fault, there is no cause of action for negligence . . . until there is 'actual loss or damage resulting to the interests of another.') (citations omitted). Otherwise, a polluter would become a health care insurer for medical procedures routinely needed to guard persons against some of the ordinary vicissitudes of life. It would convert toxic torts into a form of specialized health insurance. Imposition of liability on this basis seems to go beyond current tort theories of negligence or strict liability by requiring a polluter to pay for medical procedures that the general population should receive. Thus, Paoli II requires plaintiffs to show not only that their exposure to toxic substances is greater than normal background levels, but that the increased risk of injury from such exposure warrants medical monitoring against future illness beyond that which is recommended for everyone. See Paoli II, 35 F.3d at 788. could have detected the presence of the toxins found at the Park, and even if a test existed which could have detected a particular toxin, it would have been useful only if it were conducted within one hundred twenty days of the plaintiffs' exposure. App. at 82a. Requiring a plaintiff to produce this kind of evidence to support a finding of exposure to a toxic hazard would place an impossible burden on persons subjected to serious medical risk from toxic substances polluters have left to contaminate the environment and afflict the people who live near the wrongdoer's waste deposits. Thus, even without this direct evidence, we believe plaintiffs may still satisfy the first Paoli I factor through expert testimony showing they were exposed to the toxins at issue at levels significantly above their normal background presence so as to require special tests or more frequent medical monitoring than medicine recommends for the general population. With this in mind, we turn to the Redland FTCA Plaintiffs' expert reports to see whether any of them have produced evidence sufficient to survive summary judgment on their medical monitoring claims. Surprisingly, we discover the record has no expert opinion on whether either the Township Workers or the Neighbors have been exposed to toxins to such an extent that they suffer such an increased risk of contracting a serious disease that supplemental medical testing is reasonably required. Of all the Redland Plaintiffs, the Township Workers who excavated and levelled the contaminated landfill for four months would appear to have the highest potential for significant exposure to toxins. Yet plaintiffs' experts virtually ignore them, as well as the Neighbors, and focus their expert opinion almost exclusively on the soccer players, who would seem to have suffered a more limited risk of significant exposure, given the paucity of evidence in this record showing there were harmful quantities of contaminants in the surface soils of the playing field. Our review of the expert reports presented by the parties, as well as the soil testing analyses, indicates that the subsurface of the landfill was contaminated; but neither the EPA's nor the Corps' surface soil test results indicate contamination in the surface soil above background levels. It is undisputed that the soccer players' primary exposure for any substantial length of time was only to the surface soils on the soccer field. Without evidence showing that the surface was contaminated, the Soccer Plaintiffs cannot show significant exposure. Dr. Greeley's report relies solely on the Woodward-Clyde soil samples which were taken at some depth below the surface of the Park, and he acknowledges that the exposure values selected for use in the risk assessment may vary from the actual concentrations in the soil. Nevertheless, we believe that Dr. Greeley's report, as well as Dr. Cronce's report in which he concluded that contaminants from the subsurface could migrate upwards into the surface and that flooding of the Creek could spread contaminants on the surface, permit a reasonable factfinder to infer that adults and children using the soccer field for thirty-three hours or more were exposed to carcinogens and non-carcinogens that increased their risk of illness beyond the one-in-a-million benchmark the EPA uses to measure significant risk.9 Turning to the Redland FTCA Plaintiffs' evidence concerning special medical monitoring, the only expert report concerning the need for and extent of medical monitoring is that of Dr. Daum. She expressly states that she does not recommend special testing for any of the plaintiffs:10 I emphasize . . . that the examinations suggested [below] are not out of the ordinary, but consist of the usual adult medical examinations recommended for all adults with the adult risk of cancer in our society . . . . It is because of the increased risk of the exposures at the Marsh Run area, however, that such examinations become more urgent, and access to such examinations should not be limited to vicissitudes of employment, health insurance contract, or other individual economic difficulties . . . . She acknowledges the considerable limitations of the currently known examinations and tests for the early detection of cancer, as well as the fact that some, such as lung cancer screening, create risks that outweigh the potential benefits. She also 9 . We again note, however, that Dr. Cronce's report is not based on any study quantifying the actual effects of this hypothetical migration. We also note again that EPA's basis for its use of the one-in-a-million lifetime ratio to judge significant exposure is not readily apparent. Nevertheless, we will assume a rational basis for EPA's one-in-a-million standard in defining significant risk. See supra footnote 7. 10 . Dr. Daum does not distinguish between the different groups of Redland Plaintiffs. Rather, she refers simply to them as the individuals exposed to contaminants at the Park. App. at 3006a. declines to recommend any specific surveillance tests for any other non-cancerous chronic diseases, for the same reasons. (App. 3011) Thus, because all the Redland FTCA Plaintiffs (the Township Workers, the Neighbors and the Soccer Players) failed to introduce evidence that their exposure required a different medical monitoring regimen than that which would normally be recommended for them absent exposure, under Paoli II, we will affirm the district court's order granting summary judgment to the United States on the Redland FTCA Plaintiffs' medical monitoring claims.