Opinion ID: 2298523
Heading Depth: 2
Heading Rank: 3

Heading: John Lyford

Text: John Lyford, a seasonal heavy laborer for CPL from 1970-78, unsuccessfully applied for permanent employment as a sectionman in 1974 and 1976. In 1974, Lyford was examined by a CPL examiner who discovered that Lyford had a heart murmur. The physician nevertheless found him fit for employment as a sectionman. Dr. May's assistant, Dr. Katz, overruled that recommendation but suggested that Lyford's application would be reconsidered if Lyford were to obtain a more thorough cardiac examination. Lyford then consulted Dr. James K. Conrad, a cardiologist, who examined Lyford and forwarded the results of his examination to CPL. Dr. Conrad diagnosed Lyford's heart murmur as caused by a bicuspid aortic valve [7] ... which is of no hemodynamic consequence, i.e., it did not interfere with the flow of blood within Lyford's heart, and noted that [t]here is no reason for [Lyford] to have any reason to anticipate any real difficulty in this minimal lesion. Dr. Katz told the CPL regional superintendent that the cardiologist had confirmed Lyford's heart murmur, that the murmur was a potentially disabling condition, and that Lyford's application was again rejected. On the recommendation of his immediate supervisor, who was pleased with Lyford's work as a seasonal employee, Lyford reapplied for permanent employment as sectionman in 1976. His heart murmur was not detected during the pre-employment physical and the CPL medical examiner recommended Lyford's employment. Lyford's previous medical history was brought to Dr. May's attention, however, and Lyford was again rejected. The reason given the CPL medical examiner by Dr. May was that, according to the medical literature, Lyford's heart murmur could lead to a condition which often resulted in sudden heart failure later in life. Shortly thereafter, Lyford was medically approved for summer employment with CPL. [8] Dr. May testified that, although a biscuspid aortic valve does not in itself, pose any increased danger of sudden heart failure and does not inherently lead to further complications, a bicuspid aortic valve does lead, in a statistically significant number of cases, to aortic stenosis, a narrowing of the aortic valve opening which often results in sudden heart failure. Dr. May then testified that Lyford was rejected solely because of the general statistical link between bicuspid aortic valves and aortic stenosis, leading him to fear Lyford's potential for developing the stenosis, and with it, a risk of sudden heart failure, in the future. Dr. May did not specifically discuss Lyford's case with any cardiologists prior to either of Lyford's employment rejections and May was unable to testify as to the numerical correlation between Lyford's ailment and the aortic stenosis. Dr. Elliot A. Sagall, a CPL expert cardiological witness, agreed with Dr. May that there is no inherent link between bicuspid aortic valves and aortic stenosis. Although he testified that some persons with bicuspid aortic valves do develop aortic stenosis, he added that the onset of stenosis can generally be detected through periodic examinations. Dr. Sagall did not in any way refute the diagnosis of no hemodynamic consequence made by Lyford's cardiologist after a physical examination. Dr. Rogers, however, testified that anyone with a bicuspid aortic valve inherently suffers from aortic stenosis as well, even if the stenosis has not yet progressed to the point where it can be diagnosed.