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Committee for Finance and PersonnelDamages (Asbestos-Related Conditions) BillWritten Evidence from Dr DRT Shepherd 2nd September 2010 Department of Respiratory Medicine 2nd September 2010 Ms Laura McPolin Dear Ms McPolin Re: Consultation on the draft damages (asbestos-related conditions) (N.I. Bill 2010) I previously responded to you in January 2009 regarding the consultation paper on pleural plaques. In my response, I stated that, medically, pleural plaques do not give rise to any disability. They are simply a marker of previous asbestos exposure and therefore are a marker of a small degree of risk of possibly developing asbestos-related disease in the future. This is important to recognise that this risk is not related to the pleural plaques, but is related to their previous asbestos exposure and therefore the risks are the same between two workmen who have worked in the same firm with similar asbestos exposure, one of whom may only have pleural plaques and the other one does not. The workman with pleural plaques is at no greater risk of developing asbestos-related disease than his fellow worker without pleural plaques. It is the previous asbestos exposure, not the pleural plaques, that gives rise to the increase in risk of possibly developing asbestos-related in the future. As pleural plaques in themselves do not impair lung function or cause symptoms, it seems inappropriate that they in themselves should be compensateable and medically it does seem inappropriate that we in N. Ireland are out of step with most of the rest of the world who do not compensate pleural plaques (except possibly in Scotland). It may in fact be felt to be discriminatory against workmen with asbestos exposure but without pleural plaques to compensate only those with pleural plaques. The provision of compensation for pleural plaques is likely to increase concerns regarding their benign nature and send mixed messages to the asbestos exposed population. Attempting to allay concerns and misunderstandings of those with pleural plaques and putting in context the degree of risk involved (particularly in relation to other risks that they may take, e.g. of road traffic accidents or smoking-related risks), it seems to me to be important in correcting these misunderstandings. -2- Pleural plaques may be seen on chest x-rays. They are more frequently seen on more sophisticated examination searching for them, e.g. they are seen more frequently on CT scans and are seen more frequently than on CT scans at autopsy. Compensation for asymptomatic pleural plaques therefore risks claimants being advised to have repeated CT scans as if they are not present on initial CT scan it is possible they may be found on a later CT scan some years later. This is likely to cause unnecessary concern to the claimants and place an additional burden on investigative facilities. This is also likely to lead to a claims culture, encouraging people to get regularly tested who otherwise would probably never have known they had pleural plaques. Medically, therefore, I do not feel it is justifiable that pleural plaques in themselves should be compensated. Rather, efforts some be made to increase patient awareness and understanding and those patients who do develop asbestos-related diseases should be properly and adequately compensated. It does not seem to me to be sensible that we in N. Ireland seek to overturn a decision of the highest court in the land that has been fully considered and to put N. Ireland in a different position than most of the rest of the world, including England and Wales, in compensating asymptomatic pleural plaques. I think it is likely that the publicity regarding this new bill may unearth more cases of asymptomatic pleural plaques in those who have never known about these and lead to the development of claimants being encouraged to have regular CT scans, looking for pleural plaques. These regular CT scans, of course, have a radiation dose and an increase in radiation dose increases the risk of developing cancer. Yours sincerely Dr DRT Shepherd F.R.C.P.
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