Opinion ID: 746887
Heading Depth: 2
Heading Rank: 2

Heading: Dr. Alvarez

Text: 81 Dr. Alvarez testified that he was born in Mexico and came to the United States in 1964 for internship and residency in internal medicine, followed by two years of fellowship in pulmonary at the Baylor College of Medicine in Houston. Dr. Daniel E. Jenkins was one of Dr. Alvarez's professors at the Baylor College of Medicine. Dr. Alvarez had practiced in Houston since 1973 and was on the active staff of three, and courtesy staff of one, Houston area hospitals. 82 At the proffer stage, Dr. Alvarez, offered his opinion based on clinical medical knowledge as an internist and pulmonary specialist, enhanced by his experience in having seen fifty to sixty patients injured from exposure to chemicals, and on the facts and data contained in the medical history taken by Dr. Jenkins, the X-rays and numerous medical tests performed by Dr. Jenkins, a sinus X-ray, an allergy or RAST test performed by Dr. Alvarez tending to rule out allergies as the cause of the illness, numerous physical examinations and observations of Moore, and the manufacturer's material data sheet pertaining to the chemicals to which Moore was exposed. Applying his knowledge, education, training and experience to these facts and data, but admittedly relying heavily on Dr. Jenkins' work and opinion, Dr. Alvarez expressed his opinion that Moore suffered from reactive airways disease that had been caused by his inhalation of chemical gases while he was cleaning up the chemical spillage at Ashland. When asked whether he relied heavily on the evaluation and documentation provided from Dr. Jenkins, Dr. Alvarez replied very much. In addition, he testified that he had not seen the history and evaluations of Dr. Warren Simi first hand. Dr. Alvarez was asked how important it was to know the duration of an exposure, the amount of chemical present, the dimensions of the area or enclosure, the ventilation, and the temperature. In response, Dr. Alvarez indicated that if such data were available it would be very important, but, he explained, it is always very difficult for a medical doctor, who must make decisions as to causation and diagnosis in treating patients accidentally exposed to chemicals or other toxic substances, to obtain exact or mechanically measured data on these issues because of the very fact that the injury always results from an accident and not a controlled experiment. 83 C. Dr. Jenkins' opinion as to causation was soundly grounded in traditional clinical medical knowledge, principles and methodology. 84 Dr. Jenkins, a specialist in pulmonary and environmental disease, based his opinion on principles, theories, methodology and techniques, which are well accepted within his discipline. In summary, the proffered testimony of Dr. Jenkins reflects that he: 1) Examined Moore personally: Dr. Jenkins saw Moore on three occasions, between June 26, and August 1, 1990. On each occasion the doctor personally observed the patient. The doctor performed a thorough physical examination of Moore. (Personal observation has always been an adequate basis for an expert's opinion, and indeed has been called  'the most desirable of all bases.'  3 WEINSTEIN p 703, 703-7; Rheingold, The Basis of Medical Testimony, 15 VAND.L.REV. 473, 489 (1962)). 2) Personally took a detailed medical history from Moore: Dr. Jenkins personally took Moore's history involving his health and the accident in an interview of approximately one and one-half hours. (Reliance on patient statements to render a medical opinion is usually justified as trustworthy because patients have a strong incentive to tell their treating physician the truth--the desire to recover. In re Agent Orange Product Liability Litigation, 611 F.Supp. 1223, 1246 (E.D.N.Y.1985); Rheingold, supra at 495; Ferebee v. Chevron Chemical Co., 736 F.2d 1529, 1535 (D.C.Cir.1984)(especially when corroborated by medical records, physical examination, and medical tests); See O'Gee v. Dobbs Houses, Inc., 570 F.2d 1084 (2d Cir.1978); Birdsell v. United States, 346 F.2d 775, 780 (5th Cir.1965); Rheingold, supra at 488.) 3) Used Differential Diagnosis and Etiology: In his determination of the cause and nature of the disease, Dr. Jenkins performed or supervised a series of tests on Moore. He studied, compared and synthesized the results so as to eliminate all possibilities but the most likely diagnosis and cause of the disorder. The gamut of tests performed on Moore included pulmonary function tests, a bronchial challenge test, a bronchodilator test, an allergy test, X-rays, and laboratory tests. Dr. Jenkins and Dr. Alvarez testified that it would have been impossible for Moore to fake RAD signs on the objective tests. See Birdsell v. United States, 346 F.2d 775, 779-780 (5th Cir.1965) ([T]he physician making a diagnosis must necessarily rely on many observations and tests performed by others and recorded by them; records sufficient for diagnosis in the hospital ought to be enough for opinion testimony in the courtroom.; McCullock v. H.B. Fuller Co., 61 F.3d 1038, 1043-1044 (2nd Cir.1995); Benedi v. McNeil-P.P.C., Inc., 66 F.3d 1378, 1384 (4th Cir.1995)). 4) Reviewed tests, reports and opinions of other doctors: Dr. Jenkins reviewed the records and reports of Dr. Simi, who had seen Moore shortly after the accident. Dr. Jenkins testified that Dr. Simi's records showed even more severe airways obstruction in response to bronchial dilators which indicated there was not any question that Moore had acquired reactive airways disease. Dr. Jenkins also stated that he had reviewed the allergy studies performed by Dr. Alvarez that confirmed the reactive airways disease diagnosis and ruled out an allergic or immunologic disease as the cause. (Reliance on reports and observations of other physicians and medical technicians is accepted practice in medical field and may be relied on by expert witnesses. Jenkins v. United States, 307 F.2d 637 (D.C.Cir.1962)). 5) Reviewed the MSDS: The Occupational Safety and Health Act authorizes the Secretary to promulgate safety and health standards and requires employers to comply with them. 29 U.S.C. §§ 654(a)(2), 655. Pursuant thereto, the Hazard Communication Standard, 29 C.F.R. § 1910.1200, requires that a manufacturer of hazardous chemicals inform its own employees and downstream employers and employees of the dangers posed by the chemicals. The manufacturer is required to prepare a material safety data sheet (MSDS) for each hazardous chemical, including the identity of the chemical; health hazards posed; and handling precautions. See Martin v. American Cyanamid Co., 5 F.3d 140 (6th Cir.1993) Dr. Jenkins and Dr. Alvarez reviewed the MSDS that Dow Corning provided with the chemicals to which Moore was exposed. The MSDS is a type of fact or data reasonably relied upon by medical experts in forming opinions or inferences as to medical causation. See McCullock v. H.B. Fuller Company, 61 F.3d 1038, 1044 (2d Cir.1995). Because federal regulations require manufacturers to truthfully disclose in the MSDS the identity and health hazards of materials, it is reasonable for medical experts to rely at least in part on the MSDS in forming diagnostic and causal opinions. See also Peteet v. Dow Chemical Co., 868 F.2d 1428, 1432 (5th Cir.1989)(In making this determination, the trial court should defer to the expert's opinion of what data they find reasonably reliable.) 6) Referred to medical literature on the properties of irritant chemicals that cause RAD: Dr. Jenkins relied on a medical treatise, Carl Zenz, OCCUPATIONAL MEDICINE: PRINCIPLES AND PRACTICAL APPLICATION (2d Ed.1988), and a number of published articles in medical literature in forming his opinion or inference that the chemicals to which Moore was exposed were irritants that caused Moore's RAD. (Facts or data found in the literature of the profession, even though not themselves admissible in evidence, properly form a part of the basis for an expert's opinion. Bauman v. Centex Corporation, 611 F.2d 1115, 1120, n. 6 (5th Cir.1980) (quoting Nanda v. Ford Motor Co. 509 F.2d 213, 222 (7th Cir.1974))). 7) Utilized his training and experience: During his 53 years of medical practice, Dr. Jenkins had a considerable amount of experience with injuries caused by occupational inhalants. Due to the chemical industries along the Gulf Coast, inhalant disease victims were a large part of the patients seen by the Pulmonary and Environmental Medicine sections that Dr. Jenkins headed at Baylor College of Medicine at Houston, Texas for a combined period of 43 years. Dr. Jenkins had been called upon to make a determination whether a particular condition was caused by a particular chemical on more than one hundred occasions. (A witness's training and long experience may qualify him as an expert and enable him to assist the jury regarding subjects within his training and experience. United States v. Chappell, 6 3d. 1095, 1100 (5th Cir.1993); United States v. Hernandez-Palacios, 838 F.2d 1346, 1350 (5th Cir.1988); West Wind Africa Line, Ltd. v. Corpus Christi Marine Services Co., 834 F.2d 1232, 1236 (5th Cir.1988)).