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The House Energy and Commerce Committee sent the following letter to 13 law firms regarding their silicosis litigation. Dear [Managing Director]: For several months, this Committee has been investigating certain publichealth issues arising from the recent opinion, In Re: Silica ProductsLiability Litigation, MDL Docket No. 1553 (S.D. Tex., June 30, 2005). SinceAugust 2005, we have sent 16 letters to physicians and medical screeningcompanies identified in that opinion to gather records and information abouttheir roles in diagnosing thousands of patients with silicosis in support ofpersonal injury lawsuits. We are examining the relationships, standards, andpractices that governed such activities. While most parties have come forward with responsive records, theSubcommittee on Oversight and Investigations voted on November 3, 2005 toissue subpoenas in four instances where individual doctors either refusedto respond to our inquiry or raised claims of constitutional privilege. Atthe same time, guided by the records we have gathered, Committee staff hastraveled to Alabama, West Virginia, and Pennsylvania to interview peopleassociated with this issue and to develop our understanding of this matter.Further such trips are expected. As described in our August 2, 2005 letters, we have set out to examine therelationships, standards, and practices that governed the process describedin the In re: Silica opinion, in which a handful of physicians and medicalscreening companies generated thousands of silicosis diagnoses that laterserved as the bases for lawsuits. We are concerned by the possiblycontradictory views in this litigation among the doctors, screeners, andattorneys involved, regarding who was responsible for certain medical andethical aspects of the mass screenings – and ultimately the patients’health. Further, we are similarly troubled by perhaps differinginterpretations by the doctors, screeners, and attorneys about what, infact, is meant by a “diagnosis” of silicosis. We are concerned that there appears to be no meaningful doctor-patientrelationship established by the screening process at issue in the In Re:Silica matter. This raises a troubling health issue when the screeningprocess identifies serious medical conditions but the medical professionalsinvolved disavow responsibility for informing the patient of the finding,explaining its significance, and discussing follow-up and treatment options.It is hard to imagine circumstances where leaving such tasks to lawyerscould be considered acceptable medical practice or serving the interests ofpublic health. The health benefit of even a competent screening may well benegated by the lack of medical follow-up. Accordingly, we turn now to attorneys involved in the In Re: Silica matterseeking records and information relating to these and other issues, as setforth in our August 2, 2005 correspondence. Record and Information Requests Pursuant to Rules X and XI of the U.S. House of Representatives, pleaseprovide us with the following records and information by March 3, 2006.Please note that Request Nos. 2 – 10 ask for narrative responses or astatement of specific data. With respect to these specific Requests,answers by way of simple reference to produced documents will beinsufficient and incomplete. The breadth and timeliness of this reviewrequires each respondent to prepare and submit complete written responses tothese Requests, as appropriate. For the purposes of these Requests, “screening company” means any entityengaging in, or purporting to engage in, medical, occupational, orenvironmental surveillance or monitoring and involving the administration ofdiagnostic testing, such as x-rays, to a given population for the purpose ofdetecting or evaluating a specific health issue. Also, the term “screening”means generally all activities of such a company. Next, “you” or “your”refers to your firm as well as individually to any partner or employee.Finally, please otherwise respond to these Requests in accordance with thedefinitions attached to this letter. Requests 1. Please produce all records related to any services, analyses, reviews,consulting, or diagnoses, involving, in any way, the issue of silicosis andrelated to any of the following persons or entities: d. Heath Mason or N&M; e. Charlie Foster or RTS; f. Jeffery Guice or Occupational Diagnostics; g. David M. Miller or Inner Visions; h. Robert Altmeyer, M.D.; i. James Ballard, M.D.; j. Kevin Cooper, M.D., M.P.H.; k. Todd Coulter, M.D.; l. Andrew W. Harron, D.O.; m. Ray A. Harron, M.D.; n. Glynn Hilbun, M.D.; o. Richard B. Levine, M.D.; p. Barry S. Levy, M.D., M.P.H., P.C.; q. George Martindale, M.D.; r. W. Allen Oaks, M.D.; or s. Jay T. Segarra, M.D. 2. Please identify each physician, including all relevant names, addresses,and telephone numbers, with whom you have worked or consulted, in anymanner, related to the review, analysis, or diagnosis, or any other suchservices, of silicosis-related matters since 2000, and for each suchentity, please state the following in the format provided: a. Dates of service; b. Compensation arrangement; c. Total payments on a yearly basis since 2000; d. The total number of individual patient client matters: i. Involving an opinion making a diagnosis of silicosis upon which yourelied as a basis to file a lawsuit; ii. Involving an opinion only concurring with or supporting anotherphysician’s diagnosis of silicosis upon which you relied as a basis to filea lawsuit; iii. Involving an opinion either rejecting, disagreeing with, or notsupporting a diagnosis of silicosis; iv. Involving an opinion either making, concurring with, or supporting adiagnosis of both silicosis and asbestosis; and v. Involving an opinion as set forth in d(i)-(iv), above, and includinga written statement that the subject person/patient seek medical care forany other stated medical condition revealed in the test, x-ray, orexamination, including, but not limited to an enlarged heart, masses,fibrocalcific densities, possible tumors, nodules, fluid around the lung, orcongestive heart failure. a. b. c. d. i. ii. iii. iv. v. 3. Please identify each screening company, including all relevant names,addresses, and telephone numbers, with whom you have worked or consulted, inany manner, related to the review, analysis, or diagnosis, or any other suchservices, of silicosis-related matters since 2000, and for each such entity,please state the following in the format provided for each screeningperformed, in whole or in part, at your direction or on your behalf: a. Name of each screening company; b. Date of each screening; c. Location of each screening; d. Whether people were told at the time of the screening whether they hadbeen diagnosed with silicosis; e. Whether an employee of your firm was present at the screening seekingretainer agreements with people who were found to have silicosis; f. Total number of persons who: vi. Attended the screening; vii. Were found to have silicosis; viii. Were found not to have silicosis; ix. Were found to have both silicosis and asbestosis; g. Compensation arrangement and total payment; h. Minimum occupational exposure requirements of each screening; i. Was a physician present at the screening and, if so, x. Name of the physician; xi. Did they make diagnoses at the screening? j. Other attorney or firm participating or sponsoring the screening. a. b. c. d. e. f. g. h. i. j. i. ii. iii. iv. i. ii. 4. Please state whether you have ever held any ownership interest in anyscreening company which engaged in silicosis-related business. If so, pleaseproduce all records related to such an ownership. 5. For each matter in which you have ever filed a lawsuit or made any claimon behalf of any client alleging any injury as a result of exposure tosilica, please state the following in the format provided: a. Date of filing; b. Court; c. Status (e.g., pending, settled, dismissed with prejudice, dismissedwithout prejudice); d. Claim (e.g., silicosis or fear of silicosis); e. For each diagnosis upon which you relied as a basis to file a lawsuit,please state the following: xii. The diagnosing doctor; xiii. The date of diagnosis; xiv. The doctor who performed any B-read; and xv. Any screening company involved in developing the diagnosis. f. Please state whether a treating physician had ever concurred with thediagnosis and, if so, provide the date. g. If the diagnosis has been confirmed by any other doctor, please state: xvi. The doctor’s name; and xvii. The date of the confirming diagnosis. a. b. c. d. e. f. g. i. ii. iii. iv. i. ii. 6. With respect to the highest NIOSH B-read value (i.e., 1/0, 1/1, 1/2,etc.) given to any B-read of an x-ray of the claimants referenced above inresponse to Request No. 5, please state the total number of mattersinvolving each such B-read value in the format provided: a. NIOSH B-read value; b. Number of matters referenced above in Request No. 5 in which the highestNIOSH B-read value of an x-ray for the claimant was the corresponding value.Note that the total number of matters in column (b) should equal the totalnumber of matters identified in your response to Request No. 5. a. b. 1/0 1/1 . . . 7. Have you ever informed a client or prospective client, for the firsttime, of any tests or findings indicating that they had silicosis? If so,please state the following: a. All medical training or credentials of the person within your firm whowould first inform a client or prospective client of such a finding; b. All information regularly given to a client or prospective client of themeaning or reliability of such tests or findings; and c. Please produce all policies or procedures related thereto. 8. With respect to your silicosis-related work, please answer each of thefollowing in the affirmative or negative. a. In each instance that you received a recommendation, finding or opinionthrough a physician or screening company, as referenced in Request 2(d)(v)above, that a subject person/patient should seek medical care for any otherstated medical condition revealed in the test, x-ray, or examination, beyondany silicosis-related issues, including, but not limited to an enlargedheart, masses, fibrocalcific densities, possible tumors, nodules, fluidaround the lung, or congestive heart failure, did you as soon as reasonablypossible make each such person/patient aware of such an additionalrecommendation, finding or opinion? b. Do you ask from each client the name of any treating or primary doctorand relate all relevant medical information to that doctor? c. Have you ever referred to a physician for additional review forsilicosis, the names of clients you had previously represented in a personalinjury lawsuit? d. Have you ever referred to a screening company for screening forsilicosis, the names of clients you had previously represented in a personalinjury lawsuit? e. Have you ever filed a lawsuit alleging exposure to silicosis in whichthe diagnosis, upon which you relied as a basis to file the lawsuit, reliedupon the review of a specific x-ray that had been reviewed previously toestablish a diagnosis of asbestosis upon which a claim for exposure toasbestos had been filed? f. Does the physician who makes the diagnosis upon which you rely as abasis to file a lawsuit, speak with the subject plaintiff about the medicalsignificance, reliability, and meaning of the diagnosis? g. Does the physician who makes the diagnosis upon which you rely as abasis to file a lawsuit, have a doctor-patient relationship with thesubject plaintiff? h. Does the physician who makes the diagnosis upon which you rely as abasis to file a lawsuit, speak with the patient prior to making thediagnosis? i. Is the physician who makes the diagnosis upon which you rely as a basisto file a lawsuit, told prior to making the diagnosis whether theplaintiff, to your knowledge, has asserted any claims in the past for anyrespiratory disease or condition related to the inhalation of anysubstance, including, but not limited to, asbestos or tobacco? j. Do you make available to the physician who makes the diagnosis uponwhich you rely as a basis to file a lawsuit, all relevant records of anytreating or primary doctor of the plaintiff prior to making theirdiagnosis? k. Does the physician who makes the diagnosis upon which you rely as abasis to file a lawsuit, have, prior to making their diagnosis, a medicalhistory from the plaintiff completed by a medical professional? l. Does the physician who makes the diagnosis upon which upon which yourely as a basis to file a lawsuit, have, prior to making their diagnosis,an occupational history from the plaintiff completed by a medicalprofessional? m. Were all silicosis screenings conducted, in whole or in part, at yourdirection or on your behalf, done under the supervision of a physicianlicensed to practice and prescribe x-rays in the State in which thescreening took place? n. Were all silicosis screenings conducted, in whole or in part, at yourdirection or on your behalf, done in compliance with all relevant Statelaws, regulations, and codes concerning the administration of x-rays orother such diagnostic tests? 9. Please explain the meaning and any differences between the meaning of thefollowing: a. diagnosis of silicosis; b. findings consistent with silicosis; and c. diagnosis of silicosis, within a reasonable degree of medical certainty. 10. For each of the silica matters identified above in Request No. 5, pleaseidentify the custodian for all records, including x-rays, related to allmedical information including all records related to findings, impressions,or diagnoses of silicosis. a. Please state whether any such records have been lost, destroyed, orotherwise left your care, custody or control. b. Please state any record retention policies related to such recordsidentified above. Sincerely, Joe Barton Chairman Ed Whitfield Chairman Subcommittee on Oversight and Investigations

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