FILED: MONROE COUNTY CLERK 09/04/ :19 PM

Transcription

1 MONROE COUNTY CLERK'S OFFICE THIS IS NOT A BILL. THIS IS YOUR RECEIPT. Receipt # Book Page CIVIL Return To: No. Pages: 6 RONALD GEORGE HULL L=.stT.ment: MISCELLANEOUS DOCUMENT Control #: Index #: E Date: 02/23/2019 TORVATO, CRISTOFORO Time: 3:24:34 AM Smith, Marcella AIR & LIQUID SYSTEMS CORPORATION, ALRAY CONSTRUCTION CORP., AMTROL, INC., ATWOOD & MORRILL CO., INC. BW/IP INTERNATIONAL CO., Total Fees Paid: $0.00 Employee: State of New York MONROE COUNTY CLERK'S OFFICE WARNING - THIS SHEET CONSTITUTES THE CLERKS ENDORSEMENT, REQUIRED BY SECTION 317-a(5) & SECTION 319 OF THE REAL PROPERTY LAW OF THE STATE OF NEW YORK. DO NOT DETACH OR REMOVE. ADAM J BELLO MONROE COUNTY CLERK IIpillinlilligilli IIIIII!!iliii!iii!ii :: ;; ;;;;;;;;;;;;;;iiiiimin,gi!'!!!!!! iiii!ll!!!!!!!iillillilliiii

2 Index # : E EXH B T

3 SCHOOL OF MEDICINE & DENTISTRY Department of Medicine UNIVERSITY of Pulmonary and Critical Care Medicine Division OCHETER MEDICAL CENTER August 2, 2018 MEDICINE ofthe HIGHEST ORDER Ronald G. Hull Underberg & Kessler LLP 300 Bausch & Lomb Place Rochester, NY Re: Cristoforo Trovato v. 84 Lumbar Company, et al. Monroe DOB: 12/19/1939 County Index No.: E I Dear Mr. Hull: At your request, L reviewed-the medical. file and-chest x-rays on Mr- Cristoforo Trovato.- The file included reports from Drs. J. Kumath, H. Paszko, M. Lalkoff, A. Soliman, M. Vaughn, R. Natarajan, L. Ong, A. Maraldo, P. Patel, C. Jones, M. Milano, J. Svengsouk, P. Prasad, R. Jozefowicz, D. Bordley, S. Kothari, D. Mulford, T. Carroll, A. Nertit, E. Ramsdale, L. Algase, L. Skurpski, M. Davenport, V. Chang, Y. Ignatovich, K. Mersich, A. Saleh, and R. Jamison. There were medical records from Highland Hospital in Rochester, NY; Unity/Park Ridge Hospital in Rochester, NY; Rochester General Hospital in Rochester, NY; Strong Memorial Hospital in Rochester, NY; University of Rochester Cardiology in Rochester, NY; Westfall Cardiology in Rochester, NY; Greece Dermatological Associates in Rochester, NY; Churchville Chili Family Medicine in North Chili, NY; and Unity Internal Medicine in Rochester, NY. There were copies of Kodak Medical Records. I also reviewed x-rays and x-ray reports, procedure notes, pathology and cytology reports, EKGs and cardiac studies, and laboratory data. In addition, I reviewed Plaintiff Expert Reports submitted by Dr. J. Moline and Dr. D. Zhang (Pathology). There was a copy of the Summons and the Verified Complaint and Plaintiff's Fact Sheet. I reviewed Plaintiff's Responses to Defendants' First Set of Interrogatories and Request for Production of Documents dated October 3, There were copies of Mr. Trovato's Deposition Testimony dated October 11 and 12 and December 28 and 29, 2017 and January 28, In brief, my review of the medical file indicates that Mr. Trovato was bom December 19, He died January 27, 2018 at age 78 years old. The occupational history is noted in the Answers to Interrogatories, Depositions, Plaintiff's Fact Sheet, expert reports, and the medical records. According to the available information, Mr. Trovato started working as a laborer for Ridge Construction at an Eastman Kodak facility in 1966; after about 3 years, he transferred to Kodak and worked as a laborer, and subsequently a roofer and pipefitter. In these capacities, he alleged exposure to asbestos containing materials and equipment. He retired in 1992 reporting no asbestos exposure after He did not serve in the U.S. military. Mr. Trovato's medical history revealed multiple medical problems with a history of chronic obstructive pulmonary disease, coronary artery disease with several myocardial infarctions and stenting (2000, 2005, 2006, 2010), placement of biventricular pacemaker with ICD in 2016, cardiomyopathy, hypertension, 601 Elmwood Avenue Box 692 Rochester, NY office fax

4 August 2, 2018 Re: Cristoforo Trovato Page 2 DOB: 12/19/1939 hyperlipidemia, congestive heart failure, hepatitis, obesity, colonic polyps, nephrolithiasis, cerebrovascular accident with a lacunar infarct, vertigo, anemia, squamous cell carcinoma of the skin, and alcohol dependence. Mr. Trovato had severe coronary artery disease with reportedly 4 myocardial infarctions, multiple stents most recently in 2010, and multiple hospitalizations for chest pain. He had a history of COPD with shortness of breath on exertion and chronic cough and experienced worsening respiratory symptoms in November 2015; a chest x-ray showed a nodular recommended, as a malignancy could not be excluded. opacity in the right upper lobe and follow-up was Mr. Trovato required placement of an implantable pacemaker on December 12, 2016 and a chest x-ray revealed a mass-like opacity in the right upper lobe. A chest x-ray dated February 7, 2017 showed the right upper lobe mass had increased in size. A chest CT scan dated February 7, 2017 confirmed the large lobulated right upper lobe mass as well as a density in the lingula with several small nodular densities. Mr. Trovato was evaluated by a thoracic surgeon. A PET scan dated February 21, 2017 demonstrated marked hypermetabolic uptake by the right upper lobe mass with mediastinal adenopathy. There was moderate hypermetabolic activity by the lingula mass consistent with either a second primary tumor or a metastasis. On February 27, 2017, he underwent bronchoscopy with EBUS; the lymph nodes were negative for tumor. A needle biopsy of the lung mass on March 7, 2017 showed a non-small cell lung cancer consistent with an adenocarcinoma. Mr. Trovato was evaluated by medical oncology and radiation therapy. He was not considered a surgical candidate because of the left lung lesion and significant cardiac disease. Metastatic workup included a negative brain CT scan. He received a course of radiation to the right upper lobe mass between April 20- May 3, A chest CT angiogram dated July 10, 2017 showed a decrease in the size of the right upper lobe mass but an increase in the size of the mediastinal lymph nodes; there were nodular opacities in the left lower lobe and the right apex. He was presumed to have evidence of radiation pneumonitis and treated with a course of prednisone. A follow-up chest CT scan dated September 11, 2017 demonstrated development of innumerable pulmonary nodules suggestive of pulmonary metastases; there was a slight decrease in the size of the right upper lobe mass with progression of the radiation related scarring in the right upper lobe. His course was further complicated by several episodes of chest pain as well as GI bleeding. He was reevaluated by medical oncology and begun on immunotherapy with Pembrolizumab on September 29, A CT chest angiogram dated October 18, 2017 showed no pulmonary emboli but a further increase in the number and size of the bilateral pulmonary metastases, increased adenopathy, and new bilateral small pleural effusions. A chest CT scan dated December 11, 2017 revealed further progression of metastatic disease. Mr. Trovato's clinical status further worsened and he died January 28, Additional relevant history indicated that Mr. Trovato smoked 1.0 pack of cigarettes per day for 43 years and stopped smoking in 1996, according to the medical records. According to his deposition, he smoked packs of cigarettes/day for 36 years stopping in His medical history was remarkable for chronic obstructive pulmonary disease, coronary artery disease with several myocardial infarctions and stenting (2000, 2005, 2006, 2010), placement of biventricular pacemaker with ICD in 2016, cardiomyopathy, hypertension, hyperlipidemia, congestive heart failure, hepatitis, obesity, colonic polyps, nephrolithiasis, cerebrovascular accident with a lacunar infarct, vertigo, anemia, squamous cell carcinoma of the skin, and alcohol dependence. In addition to the bronchoscopy and needle biopsy, surgical procedures included: cardiac catheterization with multiple stents and angioplasty; cardiac catheterization in 2000, 2005,

5 August 2, 2018 Re: Cristoforo Trovato Page 3 DOB: 12/19/ , 2010, and 2016; cholecystectomy in 2010; rotator cuff repair in 2000; left trigger finger repair in 2010; right and left cataract surgery; removal of a skin cancer in 2014; and appendectomy. I reviewed multiple chest x-rays and chest CT scans. The initial PA and lateral chest x-ray dated May 17, 2010 showed a minimal amount of airspace disease in the right lower lobe probably secondary to atelectasis; there was a calcified granuloma in the right upper lobe. Chest CT scans dated May 18, November 26 and December 2, 2010 revealed bilateral lower lobe dependent atelectasis with patchy atelectasis in the left upper lobe; the right upper lobe calcified granuloma was unchanged. PA and lateral chest x-rays dated November 28 and 29, 2012 and January calcified granuloma in the right upper lobe. A chest x-ray 29 and February 17, 2015 were normal with a dated November 9, 2015 demonstrated a nodular opacity in the right upper lobe. A PA and lateral chest x-ray dated December 12, 2016 revealed a very large right upper lobe mass; a pacemaker was present in the left chest. A chest CT scan dated February 7, 2017 confinned a large lobulated right upper lobe mass adjacent to the pleura as well as a spiculated density in the left upper lobe with several small nodular densities bilaterally and a calcified granuloma in the right mid-lung. There were mild emphysematous changes but no pleural plaques or evidence of interstitial lung disease or pulmonary fibrosis. A PA and lateral chest x-ray dated June 8, 2017 showed a small decrease in the size of the right upper lobe mass but otherwise was unchanged. A chest CT scan dated July 10, 2017 demonstrated a small reduction in the size of the right upper lobe mass but an increase in the left upper lobe mass and increased mediastinal adenopathy. A follow-up chest CT scan dated September 11, 2017 revealed development of innumerable pulmonary nodules suggestive of pulmonary metastases; there was a slight decrease in the size of the right upper lobe mass with progression of the radiation related scarring in the right upper lobe. A PA chest x-ray dated October 12, 2017 showed a further increase in the size of the multiple pulmonary nodules. Chest x-rays and chest CT scans dated December 11, 2017 and January 14, 2018 demonstrated marked worsening with extensive tumor in both lung fields. There were no calcified pleural plaques. None of the films revealed evidence of interstitial fibrosis or the small peripheral opacities typically associated with pneumoconiosis. There was no evidence of asbestos-related pleural or parenchymal disease. There were multiple pulmonary function tests in the Kodak medical records from the 1980s; they revealed normal spirometry. There was a report of pulmonary function tests dated February 17, 2017, which showed a normal total lung capacity and residual volume. Spirometry revealed a low normal FVC = 77% predicted and a mildly reduced FEV1 = 76% predicted. The diffusing capacity was reportedly normal. There was no evidence of restrictive lung disease as the total lung capacity was normal. In summary, Mr. Trovato was a cigarette smoker for more than 40 years, with a history of alleged exposure to asbestos. A nodular density was noted on a chest x-ray in November A chest x-ray in December 2016 showed a right upper lobe mass and a chest CT scan in February 2017 confirmed the large mass as well as a density in the left upper lobe. A PET scan demonstrated marked hypermetabolic uptake by the right upper lobe mass with mediastinal adenopathy with moderate hypermetabolic activity by the left lung mass consistent with either a second primary tumor or a metastasis. A needle biopsy of the lung mass on March 7, 2017 showed an adenocarcinoma; a prior biopsy of the lymph nodes was negative. He was treated with a course of radiation and subsequent immunotherapy. His tumor progressed and he died January 28, From a respiratory toxicology perspective, Mr. Trovato had a history of exposure to tobacco, and worked as a laborer, roofer and pipefitter with alleged exposure to asbestos. The history of asbestos exposure is reported in the medical records.

6 August 2, 2018 Re: Cristoforo Trovato Page 4 DOB: 12/19/1939 Although Mr. Trovato may have had potential exposure to asbestos, it is-noteworthy that his- chest x-rays and chest CT scans do not demonstrate pleural plaques; the presence of plaques would have at least served as a marker of asbestos exposure. In addition, the chest x-rays and chest CT scans do not demonstrate parenchymal disease suggestive of asbestosis. Mr. Trovato had smoked 1.0 pack of cigarettes per day for approximately 43 years. He reportedly stopped smoking in It is likely that the tumor initiation occurred at least several years before it was detected clinically or radiographically. Thus, Mr. Trovato probably had stopped smoking cigarettes for, perhaps, 16 years before the appearance of his tumor. Cigarette smoking is the major cause of lung cancer in the United States. There is no doubt that cessation of smoking reduces the risk of lung cancer, and the more years one has stopped smoking, the greater the reduction in the risk of developing lung cancer. However, a recent report, published by the National Cancer Institute indicated that even after forty years of stopping smoking for individuals who had smoked cigarettes, the relative risk of developing lung cancer was still increased, according to the follow-up data of 300,000 U.S. Veterans (U.S. Department of Health and Human Service, National Cancer Institute: 1997, NIH Publication, No , Smoking and Tobacco Control Monograph 8, Chapter 7, pp ). Moreover, the duration of smoking, the daily consumption, and the age of cessation, all modify the pattern of risk reduction in ex-smokers. Mr. Trovato smoked 1.0 pack of cigarettes per day; clearly, smoking more than a half a pack per day increased the relative risk of lung cancer, based veterans' on the data Several other studies have shown that, although the risk in ex-smokers is reduced in comparison to current smokers, the risk never approached that in non-smokers, in follow-up of fifteen years of smoking cessation (Khuder & Mutgi, Chest 120: , 2001; Peto, British Medical Journal 321: , 2000). It is my opinion that Mr. Trovato had metastatic adenocarcinoma of the lung. Asbestosis is required if one is to attribute the lung cancer to asbestos. Mr. Trovato had no radiographic evidence of asbestos-related pleural disease or asbestosis. There was no evidence of restrictive lung disease, a typical f~mding in asbestosis, as the total lung capacity was normal. Furthermore, the absence of rales on multiple physical exams also speaks against asbestosis. Histological evidence for asbestosis, in this case, was not presented. In contrast, Mr. Trovato had a markedly elevated risk of lung cancer as a result of his smoking; he had smoked approximately 40 pack-years of cigarettes. Thus, in the absence of clinical, physiologic, pathologic, or radiographic asbestosis, and the presence of a long history of smoking, it is appropriate to conclude that Mr. Trovato's lung cancer was related to tobacco use, and not caused by asbestos. Please feel free to contact me if you have information. any questions regarding my report or require additional Sincerely, Mark J. Utell, MD Professor of Medicine and Environmental Medicine Director, Occupational and Environmental Medicine Division